scholarly journals Closed Reduction for the Treatment of Grade IV Supination‐External Rotation Fracture of the Ankle Joint: A Retrospective Analysis

2021 ◽  
Author(s):  
Hong‐zhou Zhao ◽  
Tong‐shun Fan ◽  
Shu‐li Wang ◽  
Li‐min Liu ◽  
Ming‐jun Liu ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Ankle Joint ◽  
Closed Reduction ◽  
External Rotation ◽  
Supination External Rotation

Ankle Joint Pressure in Supination–External Rotation Injuries: A Biomechanical Study in an Unrestrained Cadaver Model

2020 ◽  
pp. 193864002095018
Author(s):  
Andreas C. Fösel ◽  
Angela Seidel ◽  
Marc C. Attinger ◽  
Ivan Zderic ◽  
Boyko Gueorguiev ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Contact Area ◽  
Peak Pressure ◽  
External Rotation ◽  
Axial Loading ◽  
Biomechanical Study ◽  
Deltoid Ligament ◽  
Neutral Position ◽  
Joint Reaction Forces ◽  
Supination External Rotation

Background Previous biomechanical studies simulating supination–external rotation (SER) IV injuries revealed different alterations in contact area and peak pressure. We investigated joint reaction forces and radiographic parameters in an unrestrained, more physiological setup. Methods Twelve lower leg specimens were destabilized stepwise by osteotomy of the fibula (SER II) and transection of the superficial (SER IVa) and the deep deltoid ligament (SER IVb) according to the Lauge-Hansen classification. Sensors in the ankle joint recorded tibio-talar pressure changes with axial loading at 700 N in neutral position, 10° of dorsiflexion, and 20° of plantarflexion. Radiographs were taken for each step. Results Three of 12 specimen collapsed during SER IVb. In the neutral position, the peak pressure and contact area changed insignificantly from 2.6 ± 0.5 mPa (baseline) to 3.0 ± 1.4 mPa (SER IVb) ( P = .35) and from 810 ± 42 mm2 to 735 ± 27 mm2 ( P = .08), respectively. The corresponding medial clear space (MCS) increased significantly from 2.5 ± 0.4 mm (baseline) to 3.9 ± 1.1 mm (SER IVb) ( P = .028). The position of the ankle joint had a decisive effect on contact area ( P = .00), center of force ( P = .00) and MCS ( P = .01). Conclusion Simulated SER IVb injuries demonstrated radiological, but no biomechanical changes. This should be considered for surgical decision making based on MCS width on weightbearing radiographs. Levels of Evidence: Not applicable. Biomechanical study

scholarly journals Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141989086
Author(s):  
Sohail Yousaf ◽  
Alan Saleh ◽  
Aashish Ahluwalia ◽  
Shahnawaz Haleem ◽  
Zara Hayat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ankle Joint ◽  
External Rotation ◽  
Imaging Modality ◽  
Ankle Fractures ◽  
Deltoid Ligament ◽  
Stress Radiographs ◽  
Clear Space ◽  
Standard Radiographs ◽  
Supination External Rotation

Background: Isolated distal fibular fractures resulting from supination external rotation (SER) injuries without evidence of obvious talar shift on standard radiographs present a diagnostic dilemma for clinicians. The status of the deep deltoid ligament, the main stabilizer of the ankle joint, is assessed by an increase in medial clear space (MCS) on radiographs. Therefore, these injuries can be either stable or unstable. In recent years, considerable clinical and research efforts have been made to determine ankle stability following SER fracture. The purpose of this systematic review was to evaluate and compare the role of different stress radiograph modalities in assessing stability of the ankle with SER fractures with no obvious talar subluxation on standard radiographs. Methods: The electronic databases MEDLINE, EMBASE, Ovid, Cochrane Central, CINAHL, and Google Scholar were searched from January 2000 to January 2018 to identify literature relating to radiologic assessment of stability of SER ankle fractures. Results: Our literature search revealed 10 peer-reviewed articles that fulfilled inclusion criteria. This yielded a total of 698 patients. The systematic review found 3 broad categories of radiographic investigations in the assessment of ankle joint stability: external rotation (ER) stress radiographs, gravity stress views (GSV), and weightbearing (WB) radiographs. Proponents of WB radiographs have demonstrated how axial load can normalize ankle joint alignment in cases of proven instability. There was a consistently high grade of evidence for using a medial clear space (MCS) value of more than 4 to 5 mm to indicate an unstable ankle following SER fracture. Conclusion: In conclusion, the results of this systematic review support an MCS value of less than 4 to 5 mm as a good indicator of stability, regardless of choice of stress imaging modality. These patients can be allowed early weightbearing with expected good functional outcomes. Recent published literature favors WB stress radiographs as a reliable and safe technique for assessing stability in SER ankle fractures. However, it should be kept in mind that this is based on studies with relatively low grades of evidence. Level of Evidence: Level II, systematic review of variable quality studies.

The use and efficacy of intra-operative stress tests in supination-external rotation IV ankle fracture fixation

The Surgeon ◽  
2015 ◽  
Vol 13 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Sarah L. Gill ◽  
Amy Behman ◽  
Lynda A. Cochrane ◽  
Gavin J. Love
Keyword(s):  
Fracture Fixation ◽  
Ankle Fracture ◽  
External Rotation ◽  
Stress Tests ◽  
Operative Stress ◽  
Supination External Rotation

Distal Fibular Length Needed for Ankle Stability

2006 ◽  
Vol 27 (3) ◽  
pp. 185-189 ◽  
Author(s):  
Eiichi Uchiyama ◽  
Daisuke Suzuki ◽  
Hideji Kura ◽  
Toshihiko Yamashita ◽  
Gen Murakami
Keyword(s):  
Ankle Joint ◽  
External Rotation ◽  
Traction Force ◽  
Distal Fibula ◽  
Rotational Angle ◽  
Clear Cut ◽  
Long Term Stability ◽  
Ankle Stability ◽  
Fresh Frozen ◽  
The Stability

Background: The fibula is commonly used for bone grafts. Previous clinical and biomechanical studies have suggested that the length of the residual portion of the distal part of the fibula has an important effect on the long-term stability of the ankle joint. However, we cannot find clear-cut guidelines for the amount of bone that can be harvested safely. Methods: Using six normal fresh-frozen cadaver legs, motions of the tibia, talus and calcaneus were measured. The fibula was cut sequentially 3 cm from the proximal tip of the fibula and distally 10 cm, 6 cm, and 4 cm from the distal tip of the lateral malleolus. The angular motion of each bone was measured while a medial and lateral traction force of 19.6 N was applied to the proximal tibia. Angles of the tibia, talus, and calcaneus were measured. Results: Sequential resection of the fibula increased the inversion angles of the ankle joint. The proximal 3-cm cut increased the inversion angle from 42.1 ± 6.2 degrees to 49.6 ± 3.6 degrees, and the distal 4-cm cut increased the angle from 57.6 ± 6.6 degrees to 67.4 ± 5.9 degrees. The rotational angles were almost constant with sequential resections of the fibula; however, the distal 4-cm cut increased the rotational angle from 11.3 ± 25.1 degrees to 78.7 ± 37.5 degrees. Conclusions: The whole fibula including the head is essential for the stability of the ankle joint complex, and the distal fibula is responsible for stabilizing the ankle mortise during external rotation and inversion. We recommend fixation of the syndesmosis or bracing to prevent ankle joint instability with rotation of the talus in the mortise, especially when the distal fibula is shortened 6 cm or more.

Health Related Quality of Life in Patients with Supination-External Rotation Stage IV Ankle Fractures

2005 ◽  
Vol 26 (12) ◽  
pp. 1038-1041 ◽  
Author(s):  
Ryan Finnan ◽  
Luke Funk ◽  
Michael S. Pinzur ◽  
Steven Rabin ◽  
Laurie Lomasney ◽  
...  
Keyword(s):  
Quality Of Life ◽  
External Rotation ◽  
Stage Iv ◽  
Ankle Fractures ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Rotation Stage ◽  
Supination External Rotation

Background: While open reduction of displaced ankle fractures generally is accepted as the standard of care, relatively little is known about the health related quality of life after treatment. It is generally accepted that clinical results of treatment for supination-external rotation stage IV ankle fractures are favorable. The goal of this investigation was to determine the relationship between clinical results and health-related quality of life outcome measures in a consecutive series of patients treated for closed supination-external rotation stage IV ankle fractures. Methods: Twenty-six of 156 patients who had operative treatment for closed, displaced supination-external rotation stage IV ankle fractures during a 9-year period, completed the Short Musculoskeletal Function Assessment (SMFA) outcome questionnaire. Radiographs and clinical records were reviewed to determine quality of operative repair, postoperative morbidity, and the development of post-traumatic arthritis. Results: There were no postoperative complications. Of the 26 patients who returned the SMFA questionnaires, 19 had “good,” and seven had “fair” reduction of their fractures. Six showed radiographic evidence of arthritis at followup. Study participants reported scores that were similar to the general population in five of the six domains of the SMFA. Their scores in the mobility index were statistically less favorable (23.72 vs. 13.61, p = 0.016) when compared to the general population. Participants with “good” operative reductions and no evidence of arthritis at followup showed no significant difference to the general population. Participants with either a “fair” operative reduction or evidence of postoperative arthritis at followup had less favorable scores in the daily activities (mean 13.45 vs. 11.82, p = 0.004), mobility (43.43 vs. 13.61, p = 0.001), dysfunction (32.89 vs. 12.70, p = 0.014), and bother (35.80 vs. 13.77, p = 0.020) domains, when compared to the general population. Conclusions: The results of this investigation suggest that patients with excellent radiographic operative reductions and no arthritis as early as 6 months after surgery sustain no lasting unfavorable effect on health related quality of life. Patients with “fair” radiographic reduction, or presence of arthritis or both at followup, are likely to have a negative effect on their quality of life.

Stress Examination of Supination External Rotation-Type Fibular Fractures

2004 ◽  
Vol 86 (10) ◽  
pp. 2171-2178 ◽  
Author(s):  
Timothy McConnell ◽  
William Creevy ◽  
Paul Tornetta
Keyword(s):  
External Rotation ◽  
Supination External Rotation ◽  
Stress Examination

Relationship between fracture morphology of lateral malleolus and syndesmotic stability after supination-external rotation type ankle fractures

Injury ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1382-1387 ◽  
Author(s):  
Dong-Il Chun ◽  
Jahyung Kim ◽  
Yoon Seok Kim ◽  
Jae-Ho Cho ◽  
Sung-Hun Won ◽  
...  
Keyword(s):  
External Rotation ◽  
Fracture Morphology ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Supination External Rotation

scholarly journals Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0052
Author(s):  
Sohail Yousaf ◽  
Daniel Hay
Keyword(s):  
Systematic Review ◽  
External Rotation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Controlled Trials ◽  
Distal Fibula ◽  
Fibula Fracture ◽  
Stress Radiographs ◽  
The Stability ◽  
Supination External Rotation

Category: Trauma Introduction/Purpose: Differentiating stable isolated fibula fractures consistent with supination external rotation (SER) II ankle fractures from unstable SER IV fractures is essential in determining the need for surgical stabilisation. Stress radiographs are usually required to assess stability including gravity stress views (GSV) and external rotation views (ER). There is no clear consensus as to which modality is most useful to determine stability in a fracture clinic or emergency setting. In last, few years clinical uncertainty about the reliability has led researcher to focus on weight bearing radiographs (WB) .We aim to review recent literature regarding reliability of WB radiographs to estimate the stability of supination external rotation ankle fractures. Methods: A systematic review of the literature relating to radiological assessment of stability of supination external rotation ankle fractures was conducted according to PRISMA guidelines. The systematic review was prospectively registered with PROSPERO. It involved the following steps: Researching the question-Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture? Setting inclusion and exclusion criteria-All English language articles published in the including any Randomised controlled trials (RCT’s) and cohort studies. Data collection)– A literature search of Medline (PubMed), the Cochrane Bone, Joint, and Muscle Trauma Group trial register, the Cochrane central register of controlled trials, Embase and CINAHL was undertaken. The grey literature was searched. Key terms ‘supination external rotation fracture’, ‘stability’. Other variations to the key words were ‘weight bearing’, “axial load”, ‘stress x-rays’, ‘systematic reviews’ and ‘meta-analysis’. Results: A total of six studies met the inclusion criteria including 601 patients. No previous systematic review on stress radiographs including weight bearing was published. All studies concluded weight bearing radiographs is an easy, pain-free, safe and reliable method to estimate stability of isolated distal fibula fractures. No serious concerns or complications were reported. Conclusion: The evidence base contained many methodological limitations and most of the evidence was either level III or IV, and so any conclusion drawn from the research must be done so with caution. The studies suggest that GSV overestimates the instability which should be assessed with studies should focus on randomized controlled trials with narrow range of clinically useful outcome measures.

Arthroscopic Reduction and Minimally Invasive Surgery in Supination–External Rotation Ankle Fractures: A Comparative Study With Open Reduction

2019 ◽  
Vol 35 (9) ◽  
pp. 2671-2683 ◽  
Author(s):  
Chao-Ching Chiang ◽  
Yun-Hsuan Tzeng ◽  
Chien-Fu Jeff Lin ◽  
Chien-Shun Wang ◽  
Chun-Cheng Lin ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Comparative Study ◽  
Invasive Surgery ◽  
Open Reduction ◽  
External Rotation ◽  
Ankle Fractures ◽  
Arthroscopic Reduction ◽  
Supination External Rotation
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