Abstract
This study was to analyze ankle fractures for determining the epidemiology, types, distribution, possible mechanisms and diagnosis precision. Between January 2013 and December 2017, all Chinese patients older than 16 years of age with ankle fractures excluding old ankle fractures and pathological fractures in a tertiary care hospital were analyzed by using the Danis-Weber and Lauge-Hansen classification systems. Among 3952 patients with ankle fractures, 1225 fractures (31%) were Danis-Weber type A, 1640 (42%) were type B, 751 (19%) were type C, and 336 (9%) were perpendicular compression fracture. There were 1949 fractures on the left side and 2003 on the right with no significant difference (P > 0.05). Male patients between 16 and 50 years of age and women over 50 years had a higher incidence of ankle fractures accounting for 38.4% (1517/3952) and 22.2% (800/3952), respectively. Posterior malleolar fractures, fibular fractures above the inferior tibiofibular joint and Tillaux fractures were easily missed in the diagnosis, with 38 fractures (0.96%) being missed in the diagnosis. In conclusion, young and middle-aged men and older women have a higher incidence of ankle fractures, and use of the Lauge-Hansen and Danis-Weber classification systems can better help assessing the varied and complex ankle fractures, predicting the injuries, increasing diagnostic precision and decreasing misdiagnosis rate.
Highlights
The unique pattern of anatomy of the ankle and the functional relationship with the foot make the ankle highly susceptible to injuries[1,2,3,4,5]
Lauge-Hansen suggested a classification system which correlates the lines of ankle fractures with specific traumatic mechanisms[10], with the fractures being classified into four groups: supination-adduction, supination-external rotation, pronation-external rotation, and pronation-abduction
The Danis-Weber classification system was proposed by Danis and Weber according to the location of the primary fibular fracture line, with the fractures being divided into three groups: type A, type B and type C5
Summary
The unique pattern of anatomy of the ankle and the functional relationship with the foot make the ankle highly susceptible to injuries[1,2,3,4,5]. The Lauge-Hansen classification system indicates that the most frequent type is the supination-external rotation pattern with a prevalence of 40%-75% of all emergency ankle fractures This classification can be used to accurately diagnose the range of injury, identify associated ligament injuries and determine the severity of the injury as well as the degree of instability. The Danis-Weber classification system was proposed by Danis and Weber according to the location of the primary fibular fracture line, with the fractures being divided into three groups: type A (below the syndesmosis level), type B (at the syndesmosis) and type C (above the syndesmosis)[5] This classification system is simple and easy of reproduction, it does not consistently predict the scope of injury in the tibiofibular syndesmosis since types B and C can be managed in a similar approach regardless of location of fracture. This study was performed to investigate the role of the combination of the Danis-Weber and Lauge-Hansen classification systems in diagnosing ankle fractures
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