scholarly journals BIMALLEOLAR ANKLE FRACTURE: A SIMPLE FRACTURE?

2017 ◽  
Vol 25 (1) ◽  
pp. 48-51 ◽  
Author(s):  
JUNJI MILLER FUKUYAMA ◽  
ROBINSON ESTEVES SANTOS PIRES ◽  
PEDRO JOSÉ LABRONICI ◽  
JOSÉ OCTÁVIO SOARES HUNGRIA ◽  
RODRIGO LOPES DECUSATI
Keyword(s):  
Ankle Fracture ◽  
Fragment Size ◽  
External Rotation ◽  
Ankle Fractures ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Medial Malleolus ◽  
Level Of Evidence ◽  
Deltoid Ligament Injury ◽  
Supination External Rotation

ABSTRACT Objective: To evaluate the frequency of deltoid ligament injury in bimalleolar supination-external rotation type fractures and whether there is a correlation between the size of the fractured medial malleolus and deltoid ligament injury . Methods: Twenty six consecutive patients underwent magnetic resonance exams after clinical and radiographic diagnosis of bimalleolar supination-external rotation type ankle fractures . Results: Thirteen patients (50%) presented deltoid ligament injury associated to bimalleolar ankle fracture. Partial injury was present in seven (26.9%) patients and total injury in six (23.1%). Regarding medial fragment size, the average was 2.88 cm in the absence of deltoid ligament injury. Partial injuries presented 1.93 cm and total 2.1 cm on average . Conclusion: Deltoid ligament injury was present in 50% of bimalleolar ankle fractures. Smaller medial malleolus fragments, especially concerning the anterior colliculus, presented greater association with partial deltoid ligament injuries. Level of Evidence IV, Cross Sectional Study.

Correlating Arthroscopic and Radiographic Findings of Deep Deltoid Ligament Injuries in Rotational Ankle Fractures

2020 ◽  
pp. 107110072096279
Author(s):  
D’Ann Arthur ◽  
Casey Pyle ◽  
Stephen J. Shymon ◽  
David Lee ◽  
Thomas Harris
Keyword(s):  
External Rotation ◽  
Open Reduction Internal Fixation ◽  
Ankle Fractures ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Posterior Tibial Tendon ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Type Iv ◽  
Retrospective Comparative Study

Background: The deep deltoid ligament (DDL) is a key stabilizer to the medial ankle and ankle mortise and can be disrupted in ligamentous supination external rotation type IV (LSER4) ankle fractures. The purpose of this study was to define the medial clear space (MCS) measurement on injury mortise radiographs that corresponds with complete DDL injury. Methods: A retrospective record review at a level 1 hospital was performed identifying patients with LSER4 ankle fractures who underwent arthroscopy and open reduction internal fixation. Chart reviews provided arthroscopic images and operative reports. Complete DDL injury was defined as arthroscopic visualization of the posterior tibial tendon (PTT). Inability to completely visualize the PTT was defined as a partial DDL injury. MCS was measured on injury mortise radiographs. Eighteen subjects met inclusion criteria. Results: Twelve subjects had complete and 6 subjects had partial DDL injury based on arthroscopic findings. Patients with complete DDL injury and those with partial DDL injury had injury radiograph MCS ranging from 5.5 to 29.9 mm and 4.0 to 5.0 mm, respectively. All patients with MCS ≥5.5 mm on injury radiographs had complete DDL injury and all patients with MCS ≤5.0 mm on injury radiographs had partial DDL injury. Conclusion: Complete DDL injury was found on injury ankle mortise radiographs as MCS widening of ≥5.5 mm, which correlated with arthroscopic visualization of the PTT. Using this cutoff, surgeons can surmise the presence of a complete deltoid ligament injury, allowing for improved preoperative planning. Level of Evidence: Level III, retrospective comparative study.

Evaluation and Significance of Mortise Instability in Supination External Rotation Fibula Fractures: A Review Article

2018 ◽  
Vol 39 (7) ◽  
pp. 865-873 ◽  
Author(s):  
John Y. Kwon ◽  
Patrick Cronin ◽  
Brian Velasco ◽  
Christopher Chiodo
Keyword(s):  
Expert Opinion ◽  
External Rotation ◽  
Prognostic Significance ◽  
Review Article ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Deltoid Ligament ◽  
Level Of Evidence ◽  
Ankle Stability ◽  
Supination External Rotation

Evaluation and management of ankle fractures has progressed in parallel to an evolving understanding of ankle stability. While stability of the mortise had historically been attributed to the lateral malleolus, Lauge-Hansen’s contributions followed by multiple other investigations increased the emphasis on the significance of medial-sided injury in destabilizing the mortise. As the importance of the deltoid ligament has been elucidated, the means of assessing ligamentous incompetence and the prognostic significance of an unstable mortise continue to be defined. Level of Evidence: Level V, expert opinion.

scholarly journals Whether need to repair deltoid ligament injuries in Supination-external Rotation type Ⅳ ankle fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0052
Author(s):  
Yunfeng Yang
Keyword(s):  
Scoring System ◽  
External Rotation ◽  
Ankle Fractures ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Ligament Injuries ◽  
Clear Space ◽  
Significant Difference ◽  
Supination External Rotation

Category: Ankle Introduction/Purpose: To evaluate the effect of repairing deltoid ligament in patients with supination-external rotation type? ankle fractures. Methods: Between January 2013 and June 2016, 35 patients of supination-external rotation type? ankle fractures associated with deltoid ligament injury had complete medical records and were included in this study. Among all, 30 cases involved pure deltoid ligament injuries while others also included medial malleolus fractures. All fractures were treated by open reduction and internal fixation. Patients were assigned to the repaired group (21 patients) or the non-repaired group (14 patients) according to whether deltoid ligament injuries were treated during the surgery. No significant difference was found in gender, age, injury pattern, time from injury to operation(P>0.05), which was comparable. Medial clear space, visual analogue scale(VAS) score, and American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score(6 months, one year, two years after surgery), Baird-Jackson scoring system and complications were recorded. Results: Thirty-five patients were followed up 21-28months.The mean duration of operation in the repaired group was significantly longer than that of the non-repaired group.Baird-Jackson scoring system: the excellent rate of the repaired group was 90.5% while the non-repaired group was 85.7% . The VAS scores and the medial clear space of preoperative and final follow-up were significantly improved. At the last follow-up,2.85 percent of the patients presented with ankle instability while 8.5 percent of them occured traumatic arthritis. The AOFAS scores at 6, 12, and 24 months after operation were (82.1 ± 6.6; 86.2 ± 5.9; 91.5 ± 5.8) and (78.1 ± 6.5; 83.9 ± 5.6; 90.3 ± 5.6). However, none of them showed significant difference between the two groups (P>0.05). Conclusion: It’s unnecessary to repair the deltoid ligament in patients with supination-external rotation type? ankle fractures when ankle mortise restores after the fractures are fixed.

Single- vs 2-Screw Lag Fixation of the Medial Malleolus in Unstable Ankle Fractures

2019 ◽  
Vol 40 (7) ◽  
pp. 790-796 ◽  
Author(s):  
Jessica Mandel ◽  
Omar Behery ◽  
Rajkishen Narayanan ◽  
Sanjit R. Konda ◽  
Kenneth A. Egol
Keyword(s):  
Ankle Fracture ◽  
Fragment Size ◽  
Smoking Status ◽  
Medial Malleolus ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Initial Injury ◽  
American Society ◽  
Fixation Points ◽  
American Society Of Anesthesiologists

Background: The purpose of this study was to determine the efficacy of medial malleolar fixation with 1 vs 2 screws. Methods: Between April 2013 and February 2017, 196 patients who presented at 2 hospitals within one academic institution with an unstable rotational ankle fracture with a medial fracture and were treated operatively by a trained orthopedic surgeon were identified. These patients’ charts were reviewed and their injury, radiographic, surgical, and follow-up data recorded. Medial malleolus fragment size was assessed on the anteroposterior (AP) and lateral views of the initial injury radiograph. Functional outcome was assessed using Maryland Foot Score (MFS). Patients were grouped based upon the number of screws utilized to fox the medial malleolar fragment. Data were assessed using Fisher exact tests and independent t tests with SPSS, version 23. Results: Out of the 196 patients who met inclusion criteria, 47 patients (24%) were fixed with 1 medial malleolar screw and 149 patients (76%) were fixed with 2 screws. There were no differences among patients who received 1 vs 2 screws with regard to age, gender, body mass index, American Society of Anesthesiologists grade, or smoking status. The average malleolar fragment size was smaller in those treated with 1 screw on both the AP and lateral radiographic views than those with 2 screws ( P = .009, P = .001, respectively). There was no difference between groups in ankle dorsiflexion or plantarflexion at 1 year postoperation ( P = .451, P = .581). Patients who received 1 screw did not differ from those who received 2 screws with respect to Maryland Foot Scores ( P = .924). There was no difference in rate of revision surgery or need for hardware removal between groups ( P = .093). Furthermore, time to healing and postoperative complication rate did not differ between groups. Conclusion: The use of a single screw for medial malleolar fixation provided stable fixation to allow ankle fracture healing, without an increase in complications. This information is especially important in situations when the fragment is too small to accommodate multiple fixation points. Level of Evidence: Level III, retrospective case-control study.

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.

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