Ankle fractures combined with lateral ligament rupture

Abstract

Objective To investigate the diagnosis, treatment and prognosis of ankle fractures combined with rupture of lateral collateral ligaments. Methods A continuous series of 5 cases of ankle fracture combined with lateral collateral ligament injury were reviewed who had been treated by the authors from January 2014 through December 2014. They were one man and 4 women, 33 to 47 years of age (average, 39 years) . All the patients were suspected of lateral clear space of the ankle in preoperative X-ray examination, and MRI indicated rupture of lateral collateral ligament in 3 of them. Lateral collateral ligament injury was confirmed in all of them by direct intro-operative findings. After anatomical reduction and osteosynthesis of lateral and medial malleoli, the ankle joints were checked under the varus stress and drawer test. After the ruptured lateral collateral ligaments were explored directly, they were repaired with suture anchor in 4 cases and with drilling holes in the lateral malleolus in one. The ankles were immobilized for 3 weeks postoperatively. The outcomes were evaluated by Philips and Schwartz clinical scoring system and American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale. Results All the 5 patients were followed up for an average of 9.6 months (range, from 8 to 12 months) . All the fractures healed without pain. No instability was complained of. The mean degree of plantar flexion was 50.0°, with 2° (from 0° to 10°) less than the normal side; the mean degree of dorsiflexion was 17°, with 6° (from 0° to 20°) less than the normal side. The mean Philips & Schwartz score was 93.4 points (from 80 to 100 points) . The mean AOFAS score was 95.2 points (from 88 to 100 points). Conclusions The ankle fractures in which the lateral malleolus is involved can be combined with lateral collateral ligament injury. X-ray stress view and MRI are useful in early diagnosis. It is highly recommended to repair the injured lateral collateral ligament simultaneously with reduction and osteosynthesis of lateral and medial malleoli. Key words: Ankle joint; Fractures, bone; Lateral ligament, ankle; Surgical procedures