type-II Fractures Research Articles

An Atypical Type-II Monteggia Fracture Equivalent Lesion: A Case Report.

Forearm fractures are common childhood injuries, accounting for about 45% of all fractures and 62% of upper-limb fractures1-3. Approximately 75% to 84% of fractures occur in the distal third of the forearm, 15% to 18% occur in the middle third, and 1% to 7% occur in the proximal third4. Monteggia lesions account for 5% of all forearm fractures5,6. The Monteggia lesion is a radial head fracture or dislocation in association with a concomitant fracture of the metaphysis or diaphysis of the ulna2,6-11. It was first described in 1814 by Giovanni Battista Monteggia12. In 1967, Bado5 introduced a classification system for Monteggia lesions that is well established in clinical orthopaedic practice13. Bado’s classification subdivided Monteggia fracture-dislocations into four types of true Monteggia lesions; he also introduced equivalent lesions of this fracture pattern (Table I). The equivalent lesions are rare and usually occur in children14-19. Equivalent lesions are fractures that have the same mechanism of injury, with a similar radiographic pattern and method of treatment20. In 1991, Jupiter et al. provided the subclassification of a posterior Monteggia lesion based on anatomic location of the ulnar fracture and the pattern of radial head injury9. View this table: TABLE I Bado Classification for Monteggia Lesions5 The type-II Monteggia fracture is well described and has an incidence of 15% to 70%21,22. In his original classification, Bado stated that there were no equivalents to type-II Monteggia lesions other than epiphyseal fracture of the radial head or fracture of the radial neck5,20. In the orthopaedic literature, there are reports of type-II Monteggia fractures and equivalent type-II lesions (which occur mostly in adults)9, …

Gartland Type-II Supracondylar Humeral Fractures in Children

Supracondylar fractures are quite common in children. For the orthopaedists who treat them, the choice of treatment has always been clear for the type-I fracture (simple immobilization) and for the type-III fracture (operative reduction and fixation). The more difficult decision has involved the type-II fracture. The use of less aggressive treatment is supported by arguments such as: “It doesn’t look that bad,” and “The extension deformity will likely remodel.” The use of more aggressive treatment is supported by arguments such as: “The extension deformity might not remodel,” and “It’s easier to reduce and fix now than to perform an osteotomy later.” So, what is the right thing to do? Hadlow et al. found that the use of pinning in forty-eight patients with a type-II supracondylar fracture would have resulted in …

Natural History of Unreduced Gartland Type-II Supracondylar Fractures of the Humerus in Children

The preferred treatment of type-II supracondylar humeral fractures remains controversial. The purpose of this study was to evaluate the long-term clinical and radiographic outcome of type-II supracondylar humeral fractures in children treated with immobilization in a splint without reduction. The medical records of forty-six consecutive patients who sustained a supracondylar Gartland type-II fracture of the humerus treated with immobilization in a splint were reviewed. Age at the time of fracture, sex, side involved, dominant extremity, duration of immobilization, and complications were recorded. Radiographic assessment included the Baumann angle, carrying angle, and lateral humerocapitellar angle. Patients returned for clinical evaluation, and the Mayo Elbow Performance Score and the criteria of Flynn et al. were recorded. Patients completed the QuickDASH, an abbreviated form of the Disabilities of the Arm, Shoulder and Hand questionnaire, to measure disability. The average age (and standard deviation) at the time of fracture was 5.5 ± 2.6 years. The average duration of follow-up was 6.6 ± 2.8 years. The initial lateral humerocapitellar angle was a mean of 12.8° ± 9.8°, the mean Baumann angle was 12° ± 5.7°, and the mean radiographic carrying angle was 9° ± 11.3°. There were significant differences between injured and uninjured elbows at the time of follow-up with regard to flexion (mean, 137.9° ± 9.1° for injured and 144.8° ± 7.1° for uninjured elbows; p < 0.001), extension (mean, 13.2° ± 5.9° for injured and 7.4° ± 5.1° for uninjured elbows; p < 0.001), clinical carrying angle (mean, 9° ± 8.1° for injured and 12.1° ± 4.9° for uninjured elbows; p = 0.003), radiographic carrying angle (mean, 8.9° ± 8.1° for injured and 14.2° ± 5.5° for uninjured elbows; p < 0.001), and lateral humerocapitellar angle (mean, 30.5° ± 11° for injured and 41.9° ± 9.9° for uninjured elbows; p < 0.001). The mean score was 10 ± 15.3 points for the QuickDASH questionnaire, 4.7 ± 12.2 points for the QuickDASH-sports questionnaire, and 95.6 ± 10.5 for the Mayo Elbow Performance Score. According to the Flynn criteria, results were satisfactory in 80.4% of the patients. Patients with a type-II supracondylar fracture of the humerus treated conservatively had a mild cubitus varus deformity and a mild increase in elbow extension, although functional results were excellent in the majority of patients.

Surgical treatment of Neer type-II fractures of the distal clavicle

Background and purpose Type-II distal clavicle fractures according to the Neer classification are generally operated because of the high non-union rate after non-operative treatment. Several surgical techniques have been developed in order to reduce the non-union rate and improve functional outcome. This meta-analysis overviews the available surgical techniques for type-II distal clavicular fractures.Methods We searched the literature systematically. No comparative studies were found. 21 studies (8 prospective and 13 retrospective cohort studies) were selected for the meta-analysis. Data were pooled for 5 surgical outcome measures: function, time to union, time to implant removal, major complications, and minor complications.Results The 21 studies selected included 350 patients with a distal clavicular fracture. Union was achieved in 98% of the patients. Functional outcome was similar between the treatment modalities. Hook-plate fixation was associated with an 11-fold increased risk of major complications compared to intramedullary fixation and a 24-fold increased risk compared to suture anchoring.Interpretation If surgical treatment of a distal clavicle fracture is considered, a fixation procedure with a low risk of complications and a high union rate such as plate fixation or intramedullary fixation should be used. The hook-plate fixation had an increased risk of implant-related complications.

Subcutaneous Internal-External Fixation for Pelvic Fracture Fixation: A Novel Approach for Open Fracture Fixation: A Case Report.

Pelvic fractures account for 1.5% to 3% of all fractures1,2. A majority of these fractures are from low-energy mechanisms, such as a fall from standing height in elderly, osteoporotic patients. In younger patients, pelvic fractures are often the result of high-energy trauma. Of all pelvic fractures, 0.1% to 4% are open fractures1-5. Up to 72% of these represent a Gustilo-Anderson Type-III fracture caused by the large amount of force needed to penetrate the soft-tissue envelope around the pelvis6. Open fractures of the pelvic ring have been described as occurring in one of three zones: zone I, which encompasses the perineum; zone II, which encompasses the medial thigh or groin; or zone III, which encompasses the posterolateral buttock2. Open fractures associated with perineal injuries are associated with a higher mortality given the extent of injury and risk for infection. Closed fractures have a substantially lower mortality rate of 10.5%, compared with a mortality rate of up to 50% with open fractures3. The higher rate of mortality is caused by hemorrhage, associated injuries, and sepsis2,4. We present a patient with an anteroposterior compression type-II (APC-II) pelvic fracture with substantial gluteal/perineal wounds, who was treated with an anterior subcutaneous external fixator facilitating prone positioning during multiple surgical debridements. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-seven-year-old man was injured in overseas combat by an improvised explosive device. He sustained ruptured tympanic membranes; a traumatic right knee disarticulation and left transfemoral amputation; an open zone I, APC-II pelvic fracture; an open coccygeal fracture; a complex gluteal/perineal wound; and scrotal injuries. Prior to arrival at our facility, he underwent debridement of the wounds with an …

Pediatric calcaneal fractures: outcomes of surgical fixation and its characteristics

Objective The purpose of this study was to analyze the outcomes of surgical treatment of displaced intra-articular calcaneal fractures (ICFs) in children and its characteristics.Methods Between January 2004 and October 2008,we review the results of 9 displaced,intra-articular fractures in 8 skeletally immature patients,who were treated with open reduction and internal fixation in our hospital.There were 7 males and 1 female,with the mean age of 13.1 years (range:10 to 15 years).Preoperative radiographs and computed tomographic scans were used to classify fractures.Clinical and radiographic evaluation were performed in postoperative follow-up visits.The functional outcomes were assessed with use of the modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score.The published literatures of child ICFs treated with ORIF were reviewed.Results In the series,there were 4 tongue-type and 5 joint depression-type fractures according to Essex-Lopresti classification,and according to Sanders classification,we found 5 type-Ⅱ fractures,3 type-Ⅲ and 1 type-Ⅳ fractures.The mean follow-up time was 47.4 months (range:21 to 72 months).All fractures healed within 2 to 4 months.The average preoperative and postoperative Bohler angles were 5.7 and 33.1 degrees respectively,and the mean Gissane angles were 106.5 and 128.0 degrees respectively.The mean modified-AOFAS score was 65.2 points (range:53 to 68 points).Skin necrosis was found in one foot.After the review of literatures,78.6％ (48/61) of displaced ICFs were male in children.Based on the Sanders classification,36 of 67 (53.7％) were type-Ⅱ fractures,25 of 67 (37.3％) were type-Ⅲ and 6 of 67 (9.0％) were type-Ⅳ; And 15 of 37 (40.5％) were tongue-type,22 of 37 (59.5％) were joint depression-type fractures according to Essex-Lopresti classification.Conclusion Most children with displaced ICFs treated with ORIF had a good clinical outcome with few complications.The children and adolescents that were exposed to high-energy trauma suffer calcaneal fractures that were similar to adult fracture patterns. Key words: Calcaneus; Fractures, closed; Child; Treatment outcome

Radial Head and Neck Fractures: Functional Results and Predictors of Outcome

The purpose of this study was to determine the functional outcomes and predictive factors of radial head and neck fractures. Over an 18-month period, we performed a prospective study of 237 consecutive patients with a radiographically confirmed proximal radial fracture (156 radial head and 81 radial neck). Follow-up was carried out over a 1-year period using clinical and radiologic assessment, including the Mayo Elbow Score (MES). Multivariate regression analysis was used to determine significant predictors of outcome according to the MES. Of the 237 patients enrolled in the study, 201 (84.8%) attended for review, with a mean age of 44 years (range, 16-83 years; standard deviation, 17.3). One hundred eighty-seven (93%) patients achieved excellent or good MESs. The mean MES for Mason type-I (n = 103) and type-II (n = 82) fractures was excellent, with only two patients undergoing surgical intervention. For Mason type-III (n = 11) and type-IV (n = 5) fractures, the flexion arc, forearm rotation arc, and MES in the nonoperatively treated patients were not significantly different (all p ≥ 0.05) from those managed operatively. Regression analysis revealed that increasing age, increasing fracture complexity according to the AO-OTA classification, increasing radiographic comminution, and operative treatment choice were independently significant predictors of a poorer outcome (all p < 0.05). A majority of radial head and neck fractures can be treated nonoperatively, achieving excellent or good results. Age, fracture classification, radiographic comminution, and treatment choice are important factors that determine recovery.

Minimally Invasive Plate Osteosynthesis Using a Locking Compression Plate for Distal Femoral Fractures

To evaluate treatment outcomes of minimally invasive plate osteosynthesis (MIPO) for distal femoral fractures in 31 patients. 22 male and 9 female consecutive patients aged 21 to 65 (mean, 42) years underwent minimally invasive plate osteosynthesis using a locking compression plate (LCP) for distal femoral fractures. The causes of injury were vehicular accidents (n=24), falls (n=6), and assault (n=1). According to the AO classification, the fractures were classified as types A1 (n=10), A2 (n=7), and A3 (n=14). Most fractures were closed; 3 were Gustilo type-II fractures. Clinical and functional outcomes were assessed using the Knee Society Scores. The mean operating time was 70 (range, 60-100) minutes. The mean length of hospital stay was 9 (6-14) days. The mean time to union was 3.7 (range, 2.8-4.6) months. The mean follow-up period was 18 (14-26) months. At the one-year follow-up, 29 of the patients had good or excellent outcomes. No patient had angular or rotational deformity of >10º. One osteoporotic woman with a type-A1 fracture had implant failure at 10 weeks and underwent revision surgery. Another patient with a type-A1 fracture had persistent pain on the lateral aspect of the distal thigh and underwent implant removal at 22 months. No patient developed deep infection, malunion or nonunion. MIPO using a LCP achieves favourable biological fixation for distal femoral fractures with few complications. Bone grafting is not needed even in cases of metaphyseal comminution. Proper patient selection and preoperative planning are essential to prevent complications.

Operative Versus Nonoperative Management of Pipkin Type-II Fractures Associated with Posterior Hip Dislocation

Little has been written on randomized, controlled studies of operative versus nonoperative management of Pipkin type-II fractures associated with posterior dislocation of the hip. It is difficult to validate the optimal management of these fractures. The goals of this study were to (1) evaluate the results of conservative and surgical treatment for Pipkin type-II fractures associated with posterior dislocation of the hip and supply the optimal management for these fractures and (2) identify whether the Smith-Petersen approach is a safe and reliable surgical approach for Pipkin type-II fractures.Twenty-four patients were randomly divided into 2 groups: the conservative group (n=12) was treated by closed reduction, and the surgical group (n=12) was treated by primary open reduction internal fixation (ORIF) by bioabsorbable screws via a Smith-Petersen approach. Minimum follow-up was 24 months. Functional outcome was measured using the Thompson and Epstein score and the d'Aubigné-Postel score. Heterotopic ossification was classified based on the Brooker classification. The outcome of the conservative group was worse than that of the surgical group (P=.037). Two patients in the conservative group needed joint replacement for avascular necrosis of the femoral head. Heterotopic ossification was found in 6 patients (1 patient in the conservative group and 5 in the surgical group).Primary ORIF by bioabsorbable screws via a Smith-Petersen approach is an effective treatment for Pipkin type-II fractures associated with posterior dislocation.

Results of the Treatment of Talar Neck Fractures in a West African Hospital

Talar neck fractures (TNFs) are complex injuries and treatment is fraught with complications. We retrospectively studied 18 patients with TNFs: 6 Hawkins type-I, 7 type-II, 4 type-III, and 1 type-IV. Five patients with type-I and 2 with type-II fractures were treated conservatively. The remaining 11 patients underwent operative treatment. Open reduction via posterolateral approach was performed in 10 patients while closed reduction was used in one patient. All operatively reduced fractures were stabilized with screws. The following postoperative complications were encountered: wound dehiscence (n=1), avascular necrosis (n=2), and post-traumatic osteoarthritis (n=12). Fifteen patients were available for final evaluation at a mean followup period of three years (range 10 months to 6 years). Using the American Orthopaedic Foot and Ankle Society (AOFAS) score, the mean for type-I fracture was 96.4 points, 80.2 points for type-II, 68.5 points for type-III and 55 points for type-IV fractures. TNFs remain a devastating injury as the prognosis and outcomes of treatment continued to be hampered by the consequences of injury.

Occult Posterior Pelvic Ring Fractures in Elderly Patients with Osteoporotic Pubic Rami Fractures

To evaluate postoperative walking status of elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures. 33 women and 4 men aged 66 to 95 (mean, 85) years presented with osteoporotic pubic rami fractures after a fall. 22 (59%) of the patients had additional posterior pelvic ring fractures (9 had lateral compression type-II fractures involving the ilium and 13 had lateral compression type-I fractures involving the sacroalar region). Seven of the 9 patients with lateral compression type-II fractures underwent open reduction and internal fixation using plates and/ or screws. The remaining 30 patients were treated conservatively. Postoperative walking status was similar in elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures. Posterior pelvic ring fractures are easily missed in elderly patients with pubic rami fractures. Routine computed tomography of the pelvis is useful in making the diagnosis.

Timing of Wound Closure in Open Fractures Based on Cultures Obtained After Debridement

The timing of wound closure in open fractures has remained an inexact science. Numerous recommendations have been made for the management of these injuries regarding the optimal time to perform competent wound closure, with all advice based on subjective parameters. The purpose of this study was to determine the utility of a prospective protocol with use of wound cultures obtained after irrigation and debridement as a guide to the timing of wound closure following an open fracture of an extremity. Four hundred and twenty-two open fractures had emergency irrigation and debridement, fracture stabilization, and open wound management. Wound cultures were obtained for aerobic and anaerobic analysis following debridement. At forty-eight hours after debridement, patients were again returned to surgery. If the initial culture results were positive, a repeat irrigation and debridement was carried out, and additional cultures were obtained after debridement. This procedure was repeated, and the wound was not closed until negative culture results were achieved. Of the 422 open fractures, 346 were available for long-term follow-up. The overall deep infection rate was 4.3%. Gustilo Type-II fractures had a deep infection rate of 4%, and Type-III fractures had an infection rate of 5.7%. Type-III fractures demonstrated differences among the fracture patterns within this type, as infection developed in 1.8% of Type-IIIA injuries, 10.6% of Type-IIIB fractures, and 20% of Type-IIIC fractures. Fractures requiring multiple debridement procedures and those in patients with diabetes or an increased body mass index demonstrated higher rates of infection. With the numbers studied, fractures in which the wound was closed in the presence of positive cultures (a protocol breach) did not have a significantly increased risk of deep infection (p = 0.0501). The use of this standardized protocol was shown to achieve a very low rate of deep infection compared with historical controls. An increased number of irrigation and debridement procedures are required to achieve this improved outcome. Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Magnetic resonance imaging findings in 46 elbows with a radial head fracture

Background and purpose Radial head fractures are common, and may be associated with other injuries of clinical importance. We present the results of a standard additional MRI scan for patients with a radial head fracture.Patients and methods 44 patients (mean age 47 years) with 46 radial head fractures underwent MRI. 17 elbows had a Mason type-I fracture, 23 a Mason type-II fracture, and 6 elbows had a Mason type-III fracture.Results Associated injuries were found in 35 elbows: 28 elbows had a lateral collateral ligament lesion, 18 had capitellar injury, 1 had a coronoid fracture, and 1 elbow had medial collateral ligament injury.Interpretation The incidence of associated injuries with radial head fractures found with MRI was high. The clinical relevance should be investigated.

Long-Term Results of Radial Head Resection Following Isolated Radial Head Fractures in Patients Younger Than Forty Years Old

In the past, radial head resection was the surgical treatment of choice for radial head fractures that could not be internally fixed. More recently, radial head implant arthroplasty has gained popularity for the treatment of isolated radial head fractures. The purpose of the present study was to review the long-term results of radial head resection after radial head fractures not associated with elbow instability in patients younger than forty years of age. Twenty-six patients younger than forty years of age who had sustained an isolated fracture of the radial head (including six patients who had sustained a Mason type-II fracture and twenty who had sustained a Mason type-III fracture) that had been treated with primary radial head resection were reviewed retrospectively at a minimum of fifteen years (mean, twenty-five years). Outcomes were evaluated according to the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand score. Radiographic assessment of osteoarthritic changes and the carrying angle was also performed. Twenty-one patients (81%) had no elbow pain, three had mild pain, and two had moderate pain. The mean arc of motion was from 9 degrees to 139 degrees of flexion. All but one patient had a functional arc of motion. The mean pronation was 84 degrees, and the mean supination was 85 degrees. Nineteen elbows had normal strength in comparison with the unaffected side. The mean Mayo Elbow Performance Score was 95 points; the score was classified as good or excellent for twenty-four elbows (92%) and as fair for two. The mean Disabilities of the Arm, Shoulder and Hand score was 6 points. Three patients complained of wrist pain, which was mild in two patients and moderate in one. In four patients, some degree of elbow instability could be detected on physical examination. The mean carrying angle of the involved elbow was significantly greater than that of the uninjured elbow (21 degrees compared with 10 degrees). Radiographic changes of arthritis were considered mild in seventeen elbows and moderate in nine. We could not detect significant differences in functional outcome on the basis of the degree of radiographic change. Radial head resection in young patients with isolated fractures without instability yields long-term satisfactory results in >90% of cases. Osteoarthritic changes are uniformly present but typically are not associated with functional impairment.

Arthroscopically Detected Intra-Articular Lesions Associated with Acute Ankle Fractures

Anatomic surgical realignment of ankle fractures may still be associated with poor clinical outcomes, possibly as a result of occult intra-articular injury. The aim of this study was to determine if the severity of an acute ankle fracture is correlated with an increased number of arthroscopically detected intra-articular chondral lesions. We conducted a retrospective review of the medical charts on 283 ankle fractures that had been treated with open reduction and internal fixation and for which ankle arthroscopy had been routinely performed. The severity of the ankle fractures was categorized, with use of the arthroscopic findings derived from the operative reports as well as the findings on preoperative radiographs, according to the Lauge-Hansen criteria. Of the 283 patients, eighty-four (forty-four female and forty male) met our inclusion criteria. Chondral lesions were found in sixty-one patients (73%). Of seventeen fractures graded as pronation-external rotation or supination-external rotation type I according to the Lauge-Hansen classification, fifteen were associated with one or no chondral lesion and two, with two or more chondral lesions. Of ten fractures graded as pronation-external rotation or supination-external rotation type II, nine were associated with one or no chondral lesion and one, with two or more chondral lesions. Of fifty-six fractures graded as pronation-external rotation or supination-external rotation type IV, twenty-seven were associated with one or no chondral lesion and twenty-nine, with two or more chondral lesions. Type-IV pronation-external rotation and supination-external rotation ankle fractures were more likely to be associated with two or more chondral lesions than type-I fractures (odds ratio = 8.1, 95% confidence interval = 1.7 to 38.6; p = 0.0044) or type-II fractures (odds ratio = 9.7, 95% confidence interval = 1.1 to 81.5; p = 0.0172). Chondral lesions are commonly found after an acute ankle fracture. This retrospective study demonstrated that the number of intra-articular chondral lesions associated with the more severe ankle fracture patterns (pronation-external rotation and supination-external rotation type-IV fractures) was greater than the number associated with the less severe ankle fracture patterns.

Monteggia fractures in adults:Review of 48 cases

Objective To review the surgical treatment outcomes of Monteggia fractures in adults. Methods From September 1994 to January 2007, 48 patients with Monteggia fracture were treated in our hospital. The average age was 36.4 years ( 18 -66 years). According to the classification of Bado, there were 22 cases of type Ⅰ, 17 cases of type Ⅱ, 6 cases of type. Ⅲ and 3 cases of type Ⅳ fractures. In 54.2% of the patients, the lesions were associated with multiple traumas. Eight cases had radial/median/ulnar nerve injuries. In 44 cases, treatment consisted of open reduction or osteotomy and internal fixation of the ulnar fracture using different methods of ostcosynthesis (3.5 mm DCP, 3.5 mm reconstruction plates, tension band technique with Kirschner wires, and one-third tubular plates). Initial treatment of the radial head dislocation was attempted by closed reduction under fluoroscopy monitoring. Subsequent open reduction was performed in 37 cases after failed close reduction. Four of these cases underwent annular ligament repair or reconstruction. Four had partial or complete resection of the radial head. There were seven open fractures with one case developing chronic infection. Results The average foLlow-up was 17 months (6 -26 months). At the most recent follow-up examination, the average score, according to the system of Broberg and Money, was 84.2 points (range, 31 to 100 points). The result was excellent for 17 patients, good for 15, fair for 9, and poor for 7. Nine of the 16 patients who had an unsatisfactory (fair or poor) result had had a Bado type-Ⅱ fracture with a concomitant fracture of the radial head. Recovery of hand function was observed in 8 cases that had concomitant nerve injury and 6 cases that suffered nerve injury due to close reduction. Conclusion Monteggia fractures in adults are fraught with compheations despite good functional results in the majority of cases. The patient should be informed early on of the risks of residual functional deficits and the need for further surgical intervention.

Ischaemic stroke and myocardial infarction in a Caucasian patient with Moya–Moya disease

A 48-year-old male was admitted to our department after falling backwards down the stairs and resuscitation as a result of ventricular fibrillation. On admission, a CT scan was performed that ruled out intracranial bleeding, but showed posterior swelling (Panel A), and a stable type-II fracture of the odontoid process of the axis (not shown). Myocardial enzymes were elevated. Coronary angiography showed a single, >90% diameter, flow-limiting stenosis of the proximal right coronary artery (Panel B), …

Comparison of Manual and Gravity Stress Radiographs for the Evaluation of Supination-External Rotation Fibular Fractures: Gill JB, Risko R, Raducan V, et al. J Bone Joint Surg Am 2007;89:994–9

This prospective study from Texas Tech University Health Sciences evaluated the ability to determine ankle stability in isolated fibular fractures comparing manual stress radiographs to gravity stress radiographs. Twenty-five patients participated in this study, 13 having sustained supination-external rotation (SER) type-II fractures, and 12 having SER type-IV fractures. The manual stress radiographs were performed by orthopedic residents and compared to the gravity stress radiographs. Medial clear space and talar shift measurements were obtained from the radiographs to determine ankle stability.

Comparison of Manual and Gravity Stress Radiographs for the Evaluation of Supination-External Rotation Fibular Fractures

Isolated distal fibular fractures most commonly result from a supination-external rotation injury of the ankle. Deltoid ligament ruptures can also be associated with these injuries, resulting in an unstable ankle fracture due to incompetent lateral and medial restraints. We hypothesized that a gravity stress radiograph is equivalent to a manual stress radiograph for the detection of deltoid ligament injury in association with an isolated fibular fracture. All patients presenting to a level-1 trauma hospital emergency department with an isolated fibular fracture were screened. Ankle stability was determined on the basis of radiographic measurements of the medial clear space and talar shift. A manual stress radiograph and a gravity stress radiograph of the injured ankle were made for each patient. The manual stress radiograph was used to determine whether the ankle was stable or unstable. A total of twenty-five patients (thirteen with a supination-external rotation type-II fracture and twelve with a supination-external rotation type-IV-equivalent injury) were enrolled in the study. In the type-II group, the average medial clear space was 4.15 and 4.26 mm on the manual and gravity stress radiographs, respectively (p = 0.50). In the type-IV group, the average medial clear space was 5.21 and 5.00 mm on the manual and gravity stress radiographs, respectively (p = 0.69). The gravity stress radiograph is equivalent to the manual stress radiograph for determining deltoid ligament injury in association with an isolated distal fibular fracture, and thus it can be used to determine ankle stability in patients who present with an isolated distal fibular fracture.

Comparison of Manual and Gravity Stress Radiographs for the Evaluation of Supination-External Rotation Fibular Fractures

Background: Isolated distal fibular fractures most commonly result from a supination-external rotation injury of the ankle. Deltoid ligament ruptures can also be associated with these injuries, resulting in an unstable ankle fracture due to incompetent lateral and medial restraints. We hypothesized that a gravity stress radiograph is equivalent to a manual stress radiograph for the detection of deltoid ligament injury in association with an isolated fibular fracture. Methods: All patients presenting to a level-1 trauma hospital emergency department with an isolated fibular fracture were screened. Ankle stability was determined on the basis of radiographic measurements of the medial clear space and talar shift. A manual stress radiograph and a gravity stress radiograph of the injured ankle were made for each patient. The manual stress radiograph was used to determine whether the ankle was stable or unstable. Results: A total of twenty-five patients (thirteen with a supination-external rotation type-II fracture and twelve with a supination-external rotation type-IV-equivalent injury) were enrolled in the study. In the type-II group, the average medial clear space was 4.15 and 4.26 mm on the manual and gravity stress radiographs, respectively (p = 0.50). In the type-IV group, the average medial clear space was 5.21 and 5.00 mm on the manual and gravity stress radiographs, respectively (p = 0.69). Conclusions: The gravity stress radiograph is equivalent to the manual stress radiograph for determining deltoid ligament injury in association with an isolated distal fibular fracture, and thus it can be used to determine ankle stability in patients who present with an isolated distal fibular fracture. Level of Evidence: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.