A scoring system for evaluating symptoms after ankle fractures is presented. It is tested against (1) a linear analogue scale; (2) the limitation in range of motion in loaded dorsal extension; (3) the presence of osteoarthritis; and (4) the presence of dislocations on radiographs. It correlates well with these four parameters, which are considered to summarize the results after this type of injury, and is therefore considered to assess the symptoms in an objective way. The scoring system is recommended for scientific investigations, as even minor subjective differences in disability experienced by the patient are significantly separated. The use of this system will simplify the comparison of results presented by different authors.

The results of bi-and trimalleolar fractures treated with nonrigid internal fixation were analyzed in 134 patients. The fractures were of both pronation and supination type. The operative success was evaluated in terms of congruency as seen on the postoperative radiographs. The congruency was classified as either congruent, small, or grave displacement respectively. At follow-up evaluation, four variables were recorded: a linear analogue scale, an ankle score, range of motion, and presence of osteoarthritis. Fifty percent had congruent joints, 20% had small, and 30% had grave displacements. At follow-up examination those with congruent joints had significantly better function than those with displacements in all four variables. There were only minor differences between the two displacement groups. The nonrigid technique seems inadequate in retaining congruency of the unstable bi-and trimalleolar fractures. Congruency is the key to good prognosis. Even minor displacement significantly increases the risk of impending disability.tation of its effect on other than supinationeversion injuries. The functional outcome after ankle fractures is largely dependent on the congruency of the j~i n t .~'~-'~The authors have reported that the "adaptive" internal fixation according to Cedel16 is insufficient to retain an anatomic position of the fracture components of multicomponent injuries of both the supination and pronation type. Because many ankles operated on with the Cedell technique show subtle displacements, it is very interesting to see how this affects the prognosis.One aim of this study was to analyze the functional outcome after multicomponent ankle-joint injuries of both supination and pronation types were operated on according to Cedell. Another aim was to compare the results of the group with subtle displacement with the groups without and with grave displacements respectively. Today displaced fractures of the ankle joint are most often treated operatively. The results have improved compared with when conservative treatment was dominant.2 In Sweden, different methods of internal fixation are used. Maybe the most widespread technique is the MATERIALS The material consisted of 134 patients with multicomponent ankle fractures. The fractures correcounty hospital'in Sweden during a four-year period. The distributions of different fracture classes (range, 15-86). The age and sex distribution is seen in Figure 2. A posterior fragment was present in 86 fractures (68%), Of which 49 were 'I3 of the joint surface. At follow-up examination 18-54 months after injury, 127 patients were examined

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Two cases of pronation-eversion fractures, grade four, are described which were sustained during sports activities. However, in both cases the medial structures of the joint were intact. The trauma mechanism is obscure but may be explained by considering the ankle joint and the subtalar joints as a torsion transmitter as suggested by Inman (1976).

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