scholarly journals Ankle fracture – correlation of Lauge-Hansen classification and patient reported fracture mechanism

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0016
Author(s):  
Andrzej Boszczyk ◽  
Stefan Rammelt
Keyword(s):  
Fracture Mechanism ◽  
Ankle Fracture ◽  
External Rotation ◽  
Fracture Morphology ◽  
Fracture Mechanisms ◽  
X Rays ◽  
Actual Mechanism ◽  
Patient Reported ◽  
Supination External Rotation ◽  
Pronation External Rotation

Category: Trauma Introduction/Purpose: The genetic Lauge-Hansen classification is considered to provide a link between mechanism of ankle injury and resulting fracture morphology. In this study, we addressed the question of agreement between the mechanism of the fracture as postulated by the Lauge-Hansen classification and mechanism reported by the patient in rotational ankle fractures. Understanding of the actual mechanisms of ankle fracture may guide treatment decisions. Methods: Of 110 screened patients with acute malleolar fractures, 78 were able to provide information on their fracture mechanism and were included in the study. The study group consisted of 43 women and 35 men with a mean age of 47.8 (range 19.5-88.4) years. Patients were asked to describe the direction of deformation with primary question being pronation and supination as demonstrated by the examiner. As hyperplantarflexion and hyperdorsiflexion has been spontaneously reported by the patients, these directions were added to the analysis. Radiographs were analyzed according to Lauge-Hansen classification and compared with fracture mechanisms reported by the patients. Results: The majority (35/78 = 44.8%) of patients reported pronation as their fracture mechanism, 27 (34.6%) patients reported supination, 15 (19.2%) patients reported hyperplantarflexion (3 pure, one combined with pronation and 11 combined with supination), and 1 patient reported hyperdorsiflexion combined with pronation. Radiographs revealed 61 supination-external rotation (79%), 1 supination-adduction (1.3%), 14 pronation-external rotation (18%), 1 pronation-abduction (1.3%) fractures. One x-ray was unclassifiable with the Lauge-Hansen classification. The patient reported mechanisms were in concordance with the mechanism deducted from the x-rays in 49% of cases. Only 17% of patients who recalled a pronation trauma actually had radiographs classified as pronation fractures while 76% of patients who recalled a supination trauma were also radiographically classified as having sustained supination type fractures. Conclusion: The Lauge-Hansen classification should be used with caution for determining the actual mechanism of injury as it was able to predict the patient reported fracture mechanism in less than 50% of cases. A substantial percentage of fractures appearing radiographically as supination type injuries may have been actually produced by a pronation fracture mechanism.

The Surgical Treatment of the Unstable Pronation - External Rotation Ankle Fracture

1990 ◽  
Vol 25 (5) ◽  
pp. 1301
Author(s):  
Sung Won Sohn ◽  
Chang Soo Kang ◽  
Young Sik Pyun ◽  
Kwang Soon Song ◽  
Chearl Hyoung Kang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ankle Fracture ◽  
External Rotation ◽  
Pronation External Rotation

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

Osseous Talofibular Impingement after Supination–External Rotation Stage II Ankle Fracture: Case Report

2012 ◽  
Vol 33 (11) ◽  
pp. 1006-1010
Author(s):  
Michael Q. Potter ◽  
Brad D. Blankenhorn ◽  
Frank R. Avilucea ◽  
Timothy C. Beals ◽  
Florian Nickisch
Keyword(s):  
Case Report ◽  
Ankle Fracture ◽  
External Rotation ◽  
Stage Ii ◽  
Rotation Stage ◽  
Supination External Rotation

Weight-Bearing Cone-Beam CT Scan Assessment of Stability of Supination External Rotation Ankle Fractures in a Cadaver Model

2018 ◽  
Vol 39 (7) ◽  
pp. 850-857 ◽  
Author(s):  
Mark C. Lawlor ◽  
Melissa A. Kluczynski ◽  
John M. Marzo
Keyword(s):  
Ct Scan ◽  
Ankle Fracture ◽  
External Rotation ◽  
Imaging Modality ◽  
Cone Beam Ct ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Cone Beam ◽  
Clear Space ◽  
Supination External Rotation

Background: The utility of computed tomography (CT) for measuring medial clear space (MCS) for determination of the stability of supination external rotation (SER) ankle fractures and in comparison to standard radiographs is unknown. We compared MCS on gravity stress (GS) radiographs to GS and weight bearing (WB) cone-beam CT (CBCT). Methods: An AO SER 44B3.1 ankle fracture was simulated in 10 human cadavers, also serving as controls. MCS was measured on GS radiographs, GS CBCT, and a simulated WB CBCT scan. Specimens were stable if MCS was <5 mm and unstable if MCS was ≥5 mm. Paired t tests were used to compare MCS from each imaging modality for controls versus SER injuries and stable versus unstable specimens. Results: Compared with controls assessed by GS radiographs, MCS was greater for an SER injury when assessed by GS radiograph and GS CBCT scan within the stable group. Compared with controls assessed by GS radiographs, MCS was greater for SER injuries when assessed by GS radiograph, GS CBCT scan, and WB CBCT within the unstable group. MCS was reduced for stable versus unstable SER injuries assessed by WB CBCT. Conclusion: In a cadaveric model of SER ankle fracture, the medial clear space was statistically significantly greater for the experimental condition when assessed by gravity stress radiograph and gravity stress CBCT scan. Under weight-bearing conditions, the cone-beam CT scanner distinguished between stable and unstable ankles in the experimental condition. Clinical Relevance: This study suggests that a WB cone-beam CT scan may be able to distinguish between stable and unstable SER ankle fractures and influence operative decision making.

scholarly journals Comparison of below knee cast and elasticated support bandage treatment foe an isolated fracture of the lateral malleolus

2017 ◽  
Vol 17 (2) ◽  
pp. 12-17
Author(s):  
Rajram Maharjan
Keyword(s):  
Ankle Fracture ◽  
External Rotation ◽  
Lateral Malleolus ◽  
Stage Ii ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Rotation Stage ◽  
Supination External Rotation

Introduction: Ankle fractures are the most common type of fractures treated in orthopaedics with isolated malleolar fractures, accounting for two-thirds of fractures. The most common injury mechanism is supination external rotation, which accounts for the majority of all ankle fracture patterns. Supination external rotation stage II is the classic short oblique fracture of the distal fibula without a medial side injury, which responds well to non-operative treatment as it is a stable fracture. The purpose of this study is to compare efficacy of elasticated support bandage versus plaster cast in the patient with isolated lateral malleolus fracture (Lauge-Hansen supination- eversion external stage II.)Method: A prospective comparative study was carried out in the Department of Orthopaedics in Bir Hospital from February 2007 to January 2009. Patients with ankle fracture were initially treated by below knee posterior slab for seven days to allow the swelling to subside and on seventh day follow-up they were grouped in two groups. Group A were patients with below knee cast and Group B were elasticated support bandage. Both groups were followed-up in the 5th week for cast or elasticated bandage removal and were evaluated after a week, thereafter, every monthly for 3 months and finally at 6 month.Result: Of the 48 cases enrolled, the mean age of the patients was 38.85 years. The common mode of injury was fall from height followed by road traffic accident. The modified subjective ankle score of Olerud and Molander (1984) was found more in group B in comparison to group A in all follow ups. In initial three successive follow ups at 6 week, 12 week and at 3 month subjective score was found statistically significant (p> 0.05) however, it was not significant at 6 month follow up. The range of motion was significantly improved in group B in all follow ups but the difference between the two groups at 6 weeks and 10 weeks follow ups was statistically significant. Immobilized group required less analgesic but the difference was not significant statistically.Conclusion: Both below knee cast and elasticated support bandage treatment methods are safe, satisfactory and equally effective with a better early result in elasticated support bandage. Supination External Rotation stage II type fracture can be treated conservatively, if there is no medial tenderness.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 7-11

scholarly journals Functional outcome after surgical treatment of ankle fracture using Baird Jackson score

2018 ◽  
Vol 4 (4) ◽  
pp. 638
Author(s):  
Amlan Mohapatra ◽  
Karthik Raj
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
External Rotation ◽  
Clinical History ◽  
The Elderly ◽  
Factors Associated ◽  
Superficial Skin ◽  
Supination External Rotation

<p class="abstract"><strong>Background:</strong> Ankle fractures have been identified as a significant source of morbidity for both the young and the elderly. In this study we aim to evaluate the functional outcome of patients who were operated for ankle fracture at our centre and to assess the factors associated with the functional outcome.</p><p class="abstract"><strong>Methods:</strong> An observational study in the Department of Orthopedics, AJ Institute of Medical Sciences, Mangalore, Karnataka from January 1, 2017 till December 31, 2017 of all patients who presented with any type of ankle malleolar fracture and underwent surgery were included in the study. Clinical history, socio-demographic profile, anatomic classification and Weber’s classification was noted for all patients. Functional outcome was evaluated 6 months post-operatively using the Baird Jackson scale and factors associated were assessed.<strong></strong></p><p class="abstract"><strong>Results:</strong> During the study period 84 patients were enrolled in the study, mean age was 43.8±5.46 years and 48 were male patients. Supination external rotation was the most commonly seen injury in our patient population. Postoperatively, superficial skin infections were seen in 15% and restricted ankle movement in 11% patients. According to the Baird and Jackson score, clinical functional outcome was excellent in 17 cases, good in 47, fair in 15 and poor in 5 patients. Patients aged less than 45 years and supination external rotation injuries were significantly associated with excellent and good functional outcomes as compared to patients of older age.</p><p><strong>Conclusions:</strong> Surgical treatment resulted in excellent to good functional outcome in majority of the patients of this study. Further research is required to assess the clinical and functional outcomes in patients with long term follow up. </p>

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