Characteristics of supination-external rotation Salter-Harris II ankle fractures in computed tomography

Mapping Intimacies ◽

10.21203/rs.3.rs-968616/v1 ◽

2021 ◽

Author(s):

Yunfang Zhen

Keyword(s):

External Rotation ◽

Plantar Flexion ◽

Fracture Line ◽

Ankle Fractures ◽

Fibular Fracture ◽

Axial Ct ◽

The Mean ◽

Salter Harris ◽

Stage 1 ◽

Supination External Rotation

Abstract Background: Recent literature has shown that Salter-Harris (S-H)Ⅱfractures are the most common ankle fractures and carry a higher rate of growth disturbance. Recent literature has shown that Salter-Harris (S-H) Ⅱ fractures are the most common ankle fractures. CT characteristics of S-H Ⅱ ankle fractures are not well depicted. The purpose of this study was to evaluate supination-external rotation (SER) S-HⅡankle fractures by CT and to analyze the features of the associated fibular fracture to further determine the injury mechanism.Methods: The radiographs and CT with S-H Ⅱankle fractures were reviewed. Patients suffered from SER injury were included. The medial tibial cortex (MTC) of the distal tibia broken or intact, the metaphyseal fracture angle (MFA) 5-10mm proximal to the physis was documented in axial CT. The length of the metaphyseal fragment was measured in saggital CT. The correlation of the upper limits between fibular fracture and metaphyseal fragment was analyzed. In presence of the fibular fracture, the fracture pattern was classified based on the location and morphology of the fracture line.Results: Seventy-nine SER S-HⅡankle fractures were identified. Stage 1 was present in 35 and stage 2 in 44. In axial CT, the mean MFA was 11.2 degrees. MTC was fully broken in one case and 20, in stage 1 and stage 2, respectively (P=0.001). In saggital CT, the mean length of metaphyseal fragment was 35.3mm. The length of this fragment was 35.0mm, 35.5mm, in stage 1 and stage 2, respectively (P=0.868). The upper part of the fibular fracture line was located at the same level or higher than that of metaphyseal fragment. In 44 cases with associated fibular fracture, forty were in distal metaphysis with oblique fracture line for which 4 types were demonstrated with plantar flexion. Other 4 were in distal diaphysis with spiral fracture line.Conclusions: For SER S-H Ⅱ ankle fractures, MTC and orientation of the fracture plane can be shown in CT to help to make an appropriate preoperative plan. In addition to SER, majority of the concurrent fibular fracture was in the distal metaphysis with oblique fracture line and plantar flexion.

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Talus Visualization in Ankle Fractures: How Much Are We Really Seeing?

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211066856 ◽

2022 ◽

Vol 10 (1) ◽

pp. 232596712110668

Author(s):

Nathaniel B. Hinckley ◽

Jeffrey D. Hassebrock ◽

Phillip J. Karsen ◽

David G. Deckey ◽

Andrea Fernandez ◽

...

Keyword(s):

Ankle Fracture ◽

External Rotation ◽

Ankle Fractures ◽

Open Approach ◽

Appropriate Care ◽

Data Points ◽

The Mean ◽

Superior Portion ◽

Articular Pathology ◽

Supination External Rotation

Background: Despite appropriate care, a subset of patients with ankle fractures has persistent pain. This condition may be associated with intra-articular pathology, which is present up to 65% of the time. Purpose: To quantify how much of the talus is visible through an open approach to a standard supination external rotation bimalleolar ankle fracture as a percentage of the entire weightbearing surface of the talus. Study Design: Descriptive laboratory study. Methods: Standard ankle approaches to lateral and medial malleolar fractures were performed in 4 cadaveric ankles from 2 cadavers. Osteotomies were made to simulate a supination external rotation bimalleolar ankle fracture based on the Lauge-Hansen classification. The visible segments of talar cartilage were removed. The tali were then exhumed, and the entire weightbearing superior portion of the talus was assessed and compared with the amount of cartilage removed by an open approach. The mean of the data points as well as the 95% confidence interval were calculated. Results: Four ankle specimens from 2 cadavers were used for these measurements. The mean surface area of the talus was 14.0 cm2 (95% CI, 13.3-14.7 cm2), while the mean area visible via an open approach was 2.1 cm2 (95% CI, 0.5-3.6 cm2). The mean proportion of the talus visualized via an open approach was 14.8% (95% CI, 3.6-26.1%). Conclusion: These findings indicate that the true area of weightbearing talar surface visible during an open exposure may be less than what many surgeons postulate. Clinical Relevance: Only a small fracture of the talus is visible via an open approach to the talus during fracture fixation. This could warrant arthroscopic evaluation of these injuries to evaluate and treat osteocondral lesions resulting from ankle fractures.

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The Surgical Outcomes of Unstable Ankle Fractures in Patients Aged >65 Years

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459321997765 ◽

2021 ◽

Vol 12 ◽

pp. 215145932199776

Author(s):

Adem Sahin ◽

Anıl Agar ◽

Deniz Gulabi ◽

Cemil Erturk

Keyword(s):

Surgical Outcomes ◽

External Rotation ◽

High Energy ◽

Ankle Fractures ◽

Medial Malleolus ◽

Aofas Score ◽

Non Union ◽

The Mean ◽

Medial Malleolus Fracture ◽

Mechanism Of Trauma

Aim: To evaluate the surgical outcomes and complications of patients over 65 years of age, with unstable ankle fractures. Material and Method: The study included 111 patients (73F/38 M) operated on between January 2015 and February 2019 and followed up for a mean of 21.2 months (range, 6-62 months).Demographic characteristics, comorbidities, fracture type, and mechanisms of injury were evaluated. Relationships between postoperative complications and comorbidities were examined. In the postoperative functional evaluations, the AOFAS score was used and pre and postoperative mobilization (eg, use of assistive devices) was assessed. Results: The mean age of the patients was 70.5 ± 6.1 years (range, 65-90 years). The mechanism of trauma was low-energy trauma in 90.1% of the fractures and high-energy trauma in 9.9%. The fractures were formed with a SER injury (supination external rotation) in 83.7% of cases and bimalleolar fractures were seen most frequently (85/111, 76%).Complications developed in 16 (14.4%) patients and a second operation was performed in 11 (9.9%) patients with complications. Plate was removed and debridement was performed in 5 of 6 patients due to wound problems. Nonunion was developed in the medial malleolus in 4 patients. Revision surgery was performed because of implant irritation in 2 patients and early fixation loss in the medial malleolus fracture in one patient. Calcaneotibial arthrodesis was performed in 3 patients because of implant failure and ankle luxation associated with non-union. A correlation was determined between ASA score and DM and complications, but not with osteoporosis. The mean follow-up AOFAS score was 86.7 ± 12.5 (range, 36-100).A total of 94 (84.7%) patients could walk without assistance postoperatively and 92 (82.9%) were able to regain the preoperative level of mobilization. Conclusion: Although surgery can be considered an appropriate treatment option for ankle fractures in patients aged >65 years, care must be taken to prevent potential complications and the necessary precautions must be taken against correctable comorbidities.

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Stability-based classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury

Acta Orthopaedica ◽

10.3109/17453674.2012.745657 ◽

2012 ◽

Vol 83 (sup347) ◽

pp. 1-31 ◽

Cited By ~ 19

Author(s):

Harri Pakarinen

Keyword(s):

Ankle Fracture ◽

External Rotation ◽

Ankle Fractures ◽

Mechanism Of Injury ◽

Syndesmosis Injury ◽

Fracture Management ◽

Supination External Rotation

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

Foot & Ankle International ◽

10.1177/107110070502601207 ◽

2005 ◽

Vol 26 (12) ◽

pp. 1038-1041 ◽

Cited By ~ 18

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.

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

Injury ◽

10.1016/j.injury.2019.05.020 ◽

2019 ◽

Vol 50 (7) ◽

pp. 1382-1387 ◽

Cited By ~ 2

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

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00526 ◽

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.

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