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The use of weightbearing radiographs to assess the stability of supination-external rotation fractures of the ankle

  • Orthopaedic Outcome Assessment
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

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. Forty-seven patients were evaluated by questionnaire and AOFAS ankle-hindfoot score. Follow-up was 18–120 months (mean 62).

Results

Fifty-one of fifty-seven (90%) patients were found to have stable fractures (SER type II) and were treated non-operatively. The AOFAS score was 96.1 points on average (range 85–100) at latest follow-up. Four 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”.

Conclusion

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.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Bern, Inselspital, 3010, Bern, Switzerland

    Martin Weber & Fabian G. Krause

  2. Department of Orthopaedic Surgery, Kantonsspital, Schwyz, Switzerland

    Helge Burmeister

  3. Department of Orthopaedic Surgery, Zieglerspital, Berne, Switzerland

    Gerhard Flueckiger

Authors
  1. Martin Weber
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  2. Helge Burmeister
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  3. Gerhard Flueckiger
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  4. Fabian G. Krause
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Correspondence to Martin Weber.

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Weber, M., Burmeister, H., Flueckiger, G. et al. The use of weightbearing radiographs to assess the stability of supination-external rotation fractures of the ankle. Arch Orthop Trauma Surg 130, 693–698 (2010). https://doi.org/10.1007/s00402-010-1051-1

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  • DOI: https://doi.org/10.1007/s00402-010-1051-1

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