Abstract
BackgroundThe decision regarding which trans syndesmotic ankle fractures to treat surgically and which to treat non-surgically is a matter of debate. The aim of this study was to describe the epidemiology of ankle fractures treated at Sahlgrenska University Hospital (SU) during a 2-year period and analyze the current diagnostic process, classification and choice of treatment for lateral malleolar fractures at the level of the syndesmosis.MethodsObservational data regarding all ankle fractures treated at SU between 1 April 2012 and 31 March 2014 was collected from the Swedish Fracture Register. For identified AO/OTA44-B1 fractures, medical records and radiographs were reviewed and analyzed.ResultsThe study included 1332 ankle fractures. 838 (63%) were B-fractures and 512 (38%) of these were B1 fractures. 439 of the patients with B1 fractures were included in the detailed study and of these 309 (70%) were treated non-surgically and 130 patients (30%) surgically. According to the preoperative physical examination described in the medical records, medial tenderness was found in 73 (24%) of the non-surgically treated patients. Among the surgically treated patients 18% (n = 24) were found to have no medial tenderness. For the non-surgically treated patients with medial tenderness, the treatment plan was changed to surgical treatment after the 1-week radiographic follow-up in 1 patient (1%) and 1 patient (1%) was treated surgically after 3 months due to non-union.ConclusionsThe current study demonstrates the difficulty involved in distinguishing whether or not a trans-syndesmotic lateral malleolar fracture has an associated medial ligament injury or not. As this distinguishes if the fracture is stable or not it affects the choice of subsequent treatment. The results of the study also indicate a lack of consensus on how to classify and treat lateral malleolar fractures at the level of the syndesmosis. The study further suggests that there is no need to check non-surgically treated stable fractures with follow-up radiographic examination at 1 week.
Highlights
The decision regarding which trans syndesmotic ankle fractures to treat surgically and which to treat non-surgically is a matter of debate
Lateral malleolar fractures at the level of the syndesmosis, Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) 44 B fractures, are the fourth most common fracture registered in the Swedish Fracture Register (SFR) and are commonly referred to as the equivalent of Lauge-Hansen supination-external rotation (SER) injuries [8, 9] (Fig. 1)
Four of the patients had sustained 2 ankle fractures and, as a result, the total number of ankle fractures treated at Sahlgrenska University Hospital (SU) during this period was 1332
Summary
The decision regarding which trans syndesmotic ankle fractures to treat surgically and which to treat non-surgically is a matter of debate. Lateral malleolar fractures at the level of the syndesmosis, AO/OTA 44 B fractures, are the fourth most common fracture registered in the SFR and are commonly referred to as the equivalent of Lauge-Hansen supination-external rotation (SER) injuries [8, 9] (Fig. 1). Both a lateral malleolar fracture without an impaired deltoid ligament (SER-II or B1) and the combination of a lateral malleolar fracture with a deltoid ligament rupture (SER-IV or B2) appear as unimalleolar on plain radiographs (Fig. 1)
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