Relationship between fracture morphology of lateral malleolus and syndesmotic stability after supination-external rotation type ankle fractures |
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| Affiliation: | 1. Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, 657-52 Hannam-dong Yong-San Gu, Seoul, Republic of Korea;2. Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, 85, 2-ga, Jeo-dong, Jung-gu, Seoul, 100-032, Republic of Korea;3. Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, College of Medicine, 77, SakJu-Ro, Gyo-dong, Chun-Cheon, 24262, Republic of Korea;4. Department of biostatistics, Soonchunhyang University Hospital, College of medicine, 657-52 Hannam-dong Yong-San Gu, Seoul, Republic of Korea;1. Harvard Combined Orthopaedic Surgery Residency Program, Massachusetts General Hospital, Boston, MA, United States;2. Pontificia Universidad Catolica de Chile, Santiago, Chile;3. Beth Israel Deaconess Medical Center, Boston, MA, United States;1. Yale School of Medicine, Department of Orthopaedics & Rehabilitation, 800 Howard Avenue, New Haven, CT, USA;2. Institute for Global Orthopaedics and Traumatology, University of California, San Francisco 2550 23rd Street, Building 9, 3rd Floor, San Francisco, CA, 94110, USA;3. Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania;1. Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA;2. Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;3. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada |
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| Abstract: | BackgroundSyndesmotic injury with supination-external rotation (SER)-type ankle fractures are well known for the serious damages to the osseous and soft tissue envelope. However, the Lauge-Hansen classification system does not provide sufficient information related to syndesmotic injury. In this study, we aimed to investigate factors for preoperative detection of syndesmotic injury according to fracture patterns in SER III and IV ankle fractures by using radiography and computed tomography (CT).MethodsAll operative SER III and IV ankle fractures treated by a single surgeon from 2009 to 2015 were enrolled in a retrospective database. Based on computed tomographic evidence and intra-operative Cotton test, stable and unstable groups of the ankle factures were divided.ResultsA total of 52 patients with SER III, 75 patients with SER IV, and 27 patients with SER IV equivalent ankle fractures were identified, with 106 in the unstable syndesmosis group (68.8%) and 48 patients in the stable syndesmosis group (31.2%). Medial space widening and fragment angle of the fibular posterior cortex were significant predictors. The cutoff values of these factors were 4.4 mm and 32.8 degrees, respectively.ConclusionsCT was superior to simple radiography in predicting syndesmotic injury at the preoperative period in SER-type III and IV. Medial space widening and fragment angle of the fibular posterior cortex, as predictive factors, showed significant correlations. In particular, sharper fragment angle of the posterior cortex indicated higher probability of instability that remained after fracture fixation. |
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| Keywords: | Ankle fracture Malleolar fracture Syndesmosis injury SER type |
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