Correlation of AO and Lauge-Hansen Classification Systems for Ankle Fractures to the Mechanism of Injury

2013 ◽  
Vol 34 (11) ◽  
pp. 1516-1520 ◽  
Author(s):  
Edward K. Rodriguez ◽  
John Y. Kwon ◽  
Lindsay M. Herder ◽  
Paul T. Appleton
Keyword(s):  
Classification Systems ◽  
Ankle Fractures ◽  
Mechanism Of Injury

scholarly journals Findings of Routine Diagnostic Ankle Arthroscopy for Management of AO 44-C Fibular Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Daniel Dean ◽  
Francis McGuigan ◽  
Nicholas Casscells
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
High Energy ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Mechanism Of Injury ◽  
Loose Bodies ◽  
Therapeutic Benefits ◽  
Articular Damage

Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: High fibula fractures, including Maisonneuve and Weber type C fractures are commonly associated with syndesmotic injuries resulting in subluxation and dislocation of the ankle. These injuries to the joint are rarely evaluated or addressed during operative fixation, which generally consists of open reduction internal fixation of the fibula with or without fixation of the syndesmosis. Chondral lesions and loose bodies in ankle fractures may predict a poor result and can be addressed using arthroscopy to avoid exacerbating articular damage. The purpose of this study is to identify the frequency and severity of articular pathology in Weber C and Maisonneuve fibula fractures. Methods: A single surgeon case series of operatively managed ankle fractures with arthroscopic assessment from 2011-2015 was retrospectively reviewed. Inclusion criteria were patients with AO 44-C ankle fractures who were aged >17 and underwent arthroscopic assessment of the ankle joint prior to open reduction and internal fixation. Patients were excluded from the series if they presented <2 weeks from the time of injury, had a pilon variant, or had incomplete medical records available. Demographic information on the patients including age, sex, and BMI were collected. Information on mechanism of injury was recorded. Operative reports were reviewed and the presence of chondral injury and loose bodies was recorded. Descriptive statistics were performed on the collected data. Results: 18 patients (12 male, 6 female) with a mean age of 38.3 years (range 17-61; SD 13.9) were included in the case series. The average BMI 29.6 (SD 6.92). Five of the included fractures were Maisonneuve fractures while the remaining 13 were Weber C ankle fractures. The mechanism of injury of the fracture was low energy in 12, high energy in 1, and unknown in 5. On arthroscopic examination, 12 (66.7%) of the fractures were associated with full thickness articular cartilage injury requiring formal chondroplasty, 16 (88.9%) were associated with a minimum of partial articular damage, and only 2 (11.1%) had no articular damage identified on arthroscopy. Additionally, 12 (66.7%) had loose bodies that were removed during ankle arthroscopy. Conclusion: This study adds to a growing collection of literature concerning chondral injuries during ankle fractures. The data from this study suggest that AO 44-C fibular fractures are associated with a high rate of intraarticular pathology that can be effectively identified and managed during arthroscopy. Prospective studies are required to determine if there are therapeutic benefits to routine ankle arthroscopy in AO 44-C ankle fractures.

scholarly journals Factors influencing functional results after surgery for ankle fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 90-100
Author(s):  
Olivera Lupescu ◽  
Mihail Nagea ◽  
Nicolae-Marian Ciurea ◽  
Alina Grosu ◽  
Alexandru Lisias Dimitriu ◽  
...  
Keyword(s):  
Lower Limb ◽  
Functional Results ◽  
Trauma Centre ◽  
Functional Restoration ◽  
Classification Systems ◽  
Ankle Fractures ◽  
Articular Fractures ◽  
Factors Influencing ◽  
Level 1 ◽  
The Stability

Abstract Ankle fractures are frequent and have a significant impact upon the function of the lower limb, as this joint has a crucial role in standing and especially in walking. Several classification systems have been developed concerning these fractures, connecting the traumatic mechanism to their treatment. Due to their character of articular fractures, functional restoration of local anatomy is necessary; therefore, surgery is mandatory in displaced fractures, affecting the congruency, the stability or the mobility of the ankle joint. The purpose of this paper is to describe the factors influencing the results of surgical treatment in these fractures, as it results from the experience of a level 1 Trauma Centre.

317 Audit of The Management of Ankle Fractures in The Emergency Department of Leighton Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Ugwu ◽  
R Lowsby
Keyword(s):  
Emergency Department ◽  
Compliance Rate ◽  
Clinical Findings ◽  
Ankle Fractures ◽  
Mechanism Of Injury ◽  
Effective Management ◽  
British Orthopaedic Association

Abstract Background Ankle fractures are common presentations in the emergency department. The aim of treatment is to provide stability and restore alignment of the joint to as close as possible to the pre – injury state. The British Orthopaedic Association Audits Standards for Trauma (BOAST) guidelines provide clear recommendations for effective management of ankle fractures. Specific aspects of this guidelines that could be objectively assessed were selected for this audit to check if practices in the emergency department were meeting the national recommendations. Method Data was collected retrospectively. All patients with closed ankle fractures seen in the emergency department between 01/08/2020 and 31/08/2020 were included. Patients’ emergency department notes as well as electronic radiographic records were reviewed and analysed. Results There was 100% compliance rate for 3 of the domains assessed which include: clear documentations of mechanism of injury and clinical findings; documentation of co-morbidities of patients that can influence treatment and urgent performance of radiographs in clinically deformed ankles before manipulation.There was 75% compliance in performing and documentation of radiographs before transfer from the emergency. The worst domain was the re-assessment and documentation of neurovascular status post manipulation with only one reviewer out of five assessed documenting clearly after the process was completed. Conclusions Posters circulated in the department highlighting the findings of the audit. Furthermore, the LocSSIPs for reduction of ankle fractures was edited to include re-assessment of neurovascular status post manipulation.

Ankle Trauma

2019 ◽  
pp. 108-112
Author(s):  
Pavan Parasu ◽  
Winnie A. Mar
Keyword(s):  
Treatment Options ◽  
Ankle Fractures ◽  
Ankle Injuries ◽  
Mechanism Of Injury ◽  
Tibial Pilon ◽  
Imaging Characteristics ◽  
Fibular Fracture ◽  
Ankle Trauma ◽  
Imaging Strategy

Chapter 23 reviews the mechanism of injury and clinical features, imaging strategy, imaging characteristics and classification and treatment options of ankle fractures. The Lauge-Hansen and Weber classifications for malleolar fractures are described. The Lauge-Hansen classification of ankle fractures is based on the mechanism of injury. Weber classification of ankle fractures is based on the fibular fracture location relative to the ankle mortise. Pilon, Maisonneuve, and osteochondral fractures are also discussed. Ankle injuries are first evaluated with radiographs. CT examination is helpful in preoperative planning for distal tibial Pilon fractures, which are generally underestimated radiographically. MRI may be useful in determining associated ligamentous injury.

scholarly journals The frequency of proximal tibiofibular joint types in patients with malleolar fractures

2018 ◽  
Vol 17 (4) ◽  
pp. 625-630
Author(s):  
Salman Ghaffari ◽  
Masoud Shayesteh Azar ◽  
Mohammad Hossein Kariminasab ◽  
Tahereh Ranjbar ◽  
Bahman Ghaffari
Keyword(s):  
Normal Population ◽  
Adult Patients ◽  
Ankle Fractures ◽  
Ankle Injuries ◽  
Common Mechanism ◽  
Proximal Tibiofibular Joint ◽  
Mechanism Of Injury ◽  
Malleolar Fracture ◽  
Malleolar Fractures ◽  
Tibiofibular Joint

Background: Due to the prevalence of ankle malleolar fractures and by considering the influence of proximal tibiofibular joint(PTFJ) on fibula movement during ankle motion and subsequently on ankle injuries, this research was conducted to determine distributed frequency of the PTFJ in adult patients with malleolar fractures.Methods: This survey was conducted on a prospective cross-sectional basis. adult patients with malleolar fractures in two year period enrolled . Information, such as gender, age, mechanisms of fractures, reason of fractures, location of fractures was Collected, classified and reported along with descriptive statistics. Frequency of PTFJ in normal population determined and used for comparison with study group.Results: In the 79 patients could match our criteria in this study. The age of patients was 37±15 with range of 18-80 years. The highest number of ankle fractures were seen in third decade of age and these fractures were more prevalent in men. The most common cause of ankle fractures was traffic accidents (54/43%).the most common injury was lateral malleolar fracture (68/74%) and the most common mechanism of injury was Lauge-Hansen supination – external rotation, Danis-Weber type B . Frequency of PTFJ transverse and oblique types in normal population (80.6/19.4%)and study(71/29%) groups was statistically different (P < 0/05). According to mechanism of injury and location of fibular fracture, there was no significant difference between PTFJ types (P > 0/05).Conclusions: Frequency of oblique PTFJ in patients with malleolar fracture was more than normal population. There was no correlation between PTFJ type and mechanism of malleolar fracture or location of fibular fracture.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.625-630

scholarly journals Ankle Fracture Stability-based Classification

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0034
Author(s):  
James Michelson ◽  
John Delaney
Keyword(s):  
Classification System ◽  
Ankle Fracture ◽  
Area Under The Curve ◽  
Positive Outcome ◽  
Classification Systems ◽  
Ankle Fractures ◽  
Kappa Statistics ◽  
Pathologic Fractures ◽  
The Stability ◽  
Excellent Reproducibility

Category: Trauma Introduction/Purpose: Rotational ankle fractures are common in orthopaedic surgery, however existing classification systems are mostly descriptive in nature and do not explicitly guide surgical decision-making. A Stability-Based classification was developed recently to provide a more prognostic classification. The purpose of this study was to compare the reproducibility of existing ankle fracture classifications, and determine the ability of the Stability-Based classification to predict clinical treatment. Methods: One hundred ninety-three consecutive ankle fractures treated at our institution were retrospectively analyzed. Rotational type injury patterns in patients >18 years old were included. None of the subjects were clinically treated or evaluated by the study authors. The fractures were treated by attending physicians who were unaware of the Stability-Based classification system. Pathologic fractures were excluded. Three observers classified injury radiographs using the Lauge-Hansen, Weber/AO, and Stability-Based classifications systems. Reproducibility (inter-observer variation) of each classification system was calculated using kappa statistics. Prognostic values were evaluated by calculating the area under the curve (AUC) for the ROC curves (using surgery as the positive outcome) for each classification. Results: The Stability-Based classification was showed the excellent reproducibility (kappa .938, 95% CI .921-.952), along with the Weber/AO classification (kappa .97, 95% CI .961-.976), while the Lauge-Hansen had the lowest reproducibility (kappa .74, 95%CI .664-.795). The AUC for the three classifications were .883 (95%CI .852-.914), .626 (95%CI .576-.675), and .698 (95%CI .641-.755), respectively (Figure 1). The AUC was significantly better for the Stability-Based classification compared to the other 2 classifications (p<.001). Conclusion: The AO/Weber classification had excellent reproducibility, but did not predict the need for surgical stabilization accurately. In contrast, the Stability-Based classification system was both highly reproducible (kappa .938) with excellent prognostic ability to identify patients who got surgery (AUC .883). Furthermore, there were no patients who were classified as stable who failed non-operative treatment. The Stability-Based classification was found to have superior prognostic capacity compared to both the Lauge-Hansen and AO/Weber classification systems. This extends earlier studies by showing the reproducibility of the Stability-Based classification system and directly demonstrating its prognostic superiority to other classification systems.

scholarly journals Are Locked Plates Necessary to Maintain Reduction in the Treatment of Geriatric Ankle Fractures?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0019
Author(s):  
Aseel G. Dib ◽  
Caitlin Curtis Crocker ◽  
John C. Prather ◽  
Michael D. Johnson
Keyword(s):  
Bone Quality ◽  
High Energy ◽  
Fracture Pattern ◽  
Ankle Fractures ◽  
Locking Plates ◽  
Mechanism Of Injury ◽  
Trimalleolar Fractures ◽  
Loss Of Reduction ◽  
Geriatric Fractures

Category: Ankle; Trauma Introduction/Purpose: Treatment of geriatric fractures are unique in their perioperative and postsurgical complications. Increased age, increased number of comorbidities, and decreased bone quality present a significant challenge when treating geriatric fractures, including ankle fractures. Recent studies have hypothesized using locking plates will lead to better outcomes compared to non-locking plates in geriatric ankle fractures. Conventional non-locking plates depend on the bone quality and screw-plate friction in order to achieve proper fixation and stability whereas locking plates do not. Locking plates are common in this patient population due to greater rigidity and biomechanical stability while not relying on bone quality to maintain fixation. This study aims to determine if locking plates are necessary to maintain reduction in geriatric ankle fractures. Methods: After approval from the Institutional Review Board, a retrospective chart review was performed on all patients 60 years or older sustaining an ankle fracture between 2012-2018. Patients with less than 3 months follow-up at the time of injury were excluded. Each patient underwent surgical fixation at the discretion of the attending surgeon for bimalleolar or trimalleolar ankle fractures. The following patient information was collected from the charts: age, mechanism of injury, and comorbidities. Radiographic review was performed to determine open or closed fracture status, the type of fracture pattern and presence or absence of a syndesmotic injury. Patient radiographs from the most recent follow-up were analyzed for maintenance of reduction and use of a locking or non-locking plate. Statistical analysis was performed using the Chi Square Test for significance and the Fisher’s Exact Test when necessary. Results: Out of 218 patients, 143 received locking plates (L) and 75 received non-locking plates (NL). There were 99 bimalleolar fractures (69.2%) and 44 trimalleolar fractures (30.8%) in the L group. The NL group had a higher percentage of trimalleolar fractures, 50.7% (38), with 37 bimalleolar fractures (49.3%) (p=0.004). The two groups did not differ in terms of mechanism of injury (p=0.906), high energy (39.2% in L and 41.3% in NL, p=0.773), and open fractures (24.5% in L and 17.3% in NL, p=0.227). Upon radiographic review, 142 patients in the L group (0.7%) and 72 patients in the NL group (4.0%) maintained reduction (p=0.119). Loss of reduction in the L group was a trimalleolar fracture whereas 2 bimalleolar and 1 trimalleolar fractures in the NL group. Conclusion: Our study demonstrates that there is not a greater loss of reduction when utilizing locking plates. Surgeons should keep this in mind when choosing constructs for fixation of geriatric ankle fractures.

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