Weber, Arch Orthop Trauma Surg 2010 - The Use of Weightbearing Radiographs to Assess the Stability of Supination-External Rotation Fractures of the Ankle

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The Use of Weightbearing Radiographs to Assess the Stability of Supination-External Rotation Fractures of the Ankle

Weber, Krause, et al.·Arch Orthop Trauma Surg·2010·115 citations·Retrospective cohort

Free Full Text·DOI·PubMed

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Background

Isolated lateral malleolar fractures usually result from a supination-external rotation (SER) injury and may include a deltoid ligament rupture. The necessity of operative treatment is based on the recognition of a relevant medial soft-tissue disruption. Currently used tests to assess ankle stability include manual stress radiographs and gravity stress radiographs, but seem to overestimate the need for fracture fixation.

Methods

We investigated the use of weightbearing radiographs to distinguish stable and unstable isolated lateral malleolar fractures induced by the SER mechanism in 57 patients.
Patients with stable fractures (SER type II according to the Lauge-Hansen classification) were treated non-operatively with varying external support.
47 patients were evaluated by questionnaire and AOFAS ankle-hindfoot score.
Follow-up was 18-120 months (mean 62).

Results

51 of 57 (90%) patients were found to have stable fractures (SER type II) and were treated nonoperatively.
The AOFAS score was 96.1 points on average (range 85-100) at latest follow-up.
4 patients reported minor complaints.
A "moderate" correlation of risk factors (i.e. smoking) to delayed bone healing was found while the correlation of varying external support (i.e. bandage, cast) to the AOFAS score and delayed bone healing was "poor".

Conclusions

The use of weightbearing radiographs is an easy, pain-free, safe and reliable method to exclude the need for operative treatment, with excellent clinical outcome in the majority of the patients seen at latest follow-up. The delay of 3-10 days until the decision about surgical treatment is well accepted by the patients.

Copyright remains with the authors and publisher.

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The Use of Weightbearing Radiographs to Assess the Stability of Supination-External Rotation Fractures of the Ankle

Weber, Krause, et al.·Arch Orthop Trauma Surg·2010·115 citations·Retrospective cohort

Free Full Text·DOI·PubMed

|

Background

Isolated lateral malleolar fractures usually result from a supination-external rotation (SER) injury and may include a deltoid ligament rupture. The necessity of operative treatment is based on the recognition of a relevant medial soft-tissue disruption. Currently used tests to assess ankle stability include manual stress radiographs and gravity stress radiographs, but seem to overestimate the need for fracture fixation.

Methods

We investigated the use of weightbearing radiographs to distinguish stable and unstable isolated lateral malleolar fractures induced by the SER mechanism in 57 patients.
Patients with stable fractures (SER type II according to the Lauge-Hansen classification) were treated non-operatively with varying external support.
47 patients were evaluated by questionnaire and AOFAS ankle-hindfoot score.
Follow-up was 18-120 months (mean 62).

Results

51 of 57 (90%) patients were found to have stable fractures (SER type II) and were treated nonoperatively.
The AOFAS score was 96.1 points on average (range 85-100) at latest follow-up.
4 patients reported minor complaints.
A "moderate" correlation of risk factors (i.e. smoking) to delayed bone healing was found while the correlation of varying external support (i.e. bandage, cast) to the AOFAS score and delayed bone healing was "poor".

Conclusions

The use of weightbearing radiographs is an easy, pain-free, safe and reliable method to exclude the need for operative treatment, with excellent clinical outcome in the majority of the patients seen at latest follow-up. The delay of 3-10 days until the decision about surgical treatment is well accepted by the patients.

Copyright remains with the authors and publisher.

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