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Supination-External Rotation Ankle Fractures: Stability a Key Issue

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Stability is a key issue in treating supination-external rotation ankle fractures, but we do not know how it affects functional outcome and subsequent development of radiographic osteoarthritis. With a systematic literature review, we identified 11 clinical studies (Level IV evidence) published in peer-reviewed journals reporting on at least 10 ankles. Followup was at least 1 year. Two authors independently scored the quality of the studies using the modified Coleman Methodology Score; the mean score was 58 of 100, with substantial agreement between the two examiners. Four studies used a general health assessment questionnaire. Several literature limitations (debatable fracture stability criteria, few cohort studies with heterogeneous methodology, small patient numbers and limited followup in some studies) do not allow definitive conclusions. Of 213 stable fractures treated nonoperatively, 2.8% of ankles had radiographic osteoarthritis develop (18 years’ mean followup) and 84% were free of symptoms. The incidence of radiographic osteoarthritis in 420 unstable fractures treated operatively was 20.9% at 5.5 years versus 65.5% at 6.8 years in 137 ankles treated nonoperatively. The complication rate in 355 operatively treated fractures was 10.4%. A medial malleolus fracture, female gender, older age, higher American Society of Anesthesiologists grade, smoking, and lower educational level negatively influenced general health outcome, physical function, and pain.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, Frimley Park Hospital, Surrey, UK

    Nikolaos Gougoulias MD, PhD & Anthony Sakellariou FRCS(Orth)

  2. Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, Staffordshire, UK

    Anil Khanna MRCS, MS(Ortho)

  3. Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK

    Nicola Maffulli MD, MS, PhD, FRCS(Orth)

Authors
  1. Nikolaos Gougoulias MD, PhD
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  2. Anil Khanna MRCS, MS(Ortho)
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  3. Anthony Sakellariou FRCS(Orth)
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  4. Nicola Maffulli MD, MS, PhD, FRCS(Orth)
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Correspondence to Nicola Maffulli MD, MS, PhD, FRCS(Orth).

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

This work was performed at Centre for Sports and Exercise Medicine and Frimley Park Hospital.

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Gougoulias, N., Khanna, A., Sakellariou, A. et al. Supination-External Rotation Ankle Fractures: Stability a Key Issue. Clin Orthop Relat Res 468, 243–251 (2010). https://doi.org/10.1007/s11999-009-0988-2

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  • DOI: https://doi.org/10.1007/s11999-009-0988-2

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