Association Between Syndesmotic Stability and Fracture Patterns of Lateral Malleolus After Supination-External Rotation-Type Ankle Fractures

Abstract

Category:Ankle, TraumaIntroduction/Purpose:Syndesmotic injury with supination-external rotation (SER)-type ankle fractures are well known for the serious damages to the osseous and soft tissue envelope. However, the Lauge-Hansen classification system does not provide sufficient information related to syndesmotic injury. In this study, we aimed to investigate factors for preoperative detection of syndesmotic injury according to fracture patterns in SER III and IV ankle fractures by using radiography and computed tomography (CT).Methods:All operative SER III and IV ankle fractures treated by a single surgeon from 2009 to 2015 were enrolled in a retrospective database. Based on computed tomographic evidence and intra-operative cotton test, two groups of the ankle factures were divided(stable and unstable). And .2%). Medial space widening and fragment angle of the fibular posterior cortex were measured (Figure1).Results:A total of 52 patients with SER III, 75 patients with SER IV, and 27 patients with SER IV equivalent ankle fractures were identified, with 106 in the unstable syndesmosis group (68.8%) and 48 patients in the stable syndesmosis group (31.2%). Medial space widening and fragment angle of the fibular posterior cortex were significant predictors(p<0.01, p<0.01, respectively). The cutoff values of these factors were 4.4 mm and 32.8 degrees, respectively (Figure2).Conclusion:In predicting syndesmotic injury at the preoperative period in SER-type III and IV, medial clear space widening and fragment angle of the fibular posterior cortex showed significant correlations. In particular, sharper fragment angle of the posterior cortex indicated higher probability of instability that remained after fracture fixation.