Paratrooper's Ankle Fracture: Posterior Malleolar Fracture

Abstract

BackgroundWe assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes.MethodsFifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity.ResultsThe patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome.ConclusionsPosterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to undergo surgical repairs.

Radiographic Imaging of Parachuting-Related Ankle Fractures: Case Series

“…Other mechanisms predisposing to injury include double-leg landing, which distributes force to the knees and femurs, and single-leg landing, which distributes force to the ankle and hip [13]. In one retrospective study, the posterior malleolar fracture has been shown to constitute 41% of fractures sustained in parachute landings [10].…”

“…Imaging studies for ankle injuries sustained during landing frequently show nonspecific soft tissue swelling, reflecting the prevalence of ankle sprains and other soft-tissue injuries in this population. Characterization of the less-frequent parachute-related ankle fracture has been explored in the literature, albeit to a lesser degree [ 10 ]. We present 10 cases of parachute-related ankle fractures sustained by BAC trainees in order to demonstrate the different presentations of this unique traumatic entity.…”

Fracture of the posterior malleolus: an underdiagnosed condition

“…15 Nevertheless, other mechanisms may also lead this particular ankle fracture. 9 Based on radiography and computed tomography (CT), Haraguchi and collaborators divided the posterior malleolus fractures in three different types: type 1, fracture of the posterolateral portion of the tibia; type 2, fracture of the posterolateral portion of the tibia up to the medial malleolus; type 3, one or more small fragments of the posterior lip of the malleolus. 6 Taking into account that these particular fracture symptoms may simulate an ankle sprain, it is crucial to perform a differential diagnosis examination.…”

“…8 Usually, these fractures are related to a specific injury mechanism comprising, plantar flexion in axial load at the moment of ground impact, supination or external rotation of the talus in axial load, or progressive external rotation of the talus. 9 Given the need to standardize the diagnosis and complementary imaging procedures on ankle injuries, Stiell and collaborators created the "Ottawa Ankle Rules", a clinical and radiological decision algorithm aiming to reduce the high number of radiographs made at the ankle joint, often considered unnecessary. 10 This clinical decision model has been widely used in…”

Axillary Brachial Plexus Block Application for Reduction of Radius Head Fracture and Elbow Dislocation which Developed after the Trauma in Vertical Wind Tunnels

“…This repetitive training includes different stages, such as exiting the plane, free-fall and landing. The preliminary training required before skydiving can begin is held at simulation center suitable for all phases (2). To attain and maintain the level of training and skill necessary for the free-fall stage, vertical wind tunnels (VWTs) are used.…”