Radiographic Detection of Marginal Impaction in Supination-Adduction Ankle Fractures

Alluri, Ram K.; Hill, J. Ryan; Donohoe, Steven; Fleming, Mark E.; Tan, Eric W.; Marecek, Geoffrey S.

doi:10.1177/1071100717709565

Cited by 12 publications

(9 citation statements)

References 15 publications

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“…This special type of fracture has characteristics that other traditional ankle fractures do not have, as follows: 1) lateral collateral ligament injury; 2) subchondral bone and cartilage injury of the medial malleolus; 3) a horizontal lateral fracture line of the ankle and vertical fracture line of the medial malleolus; 4) a die-punch-like fragment of the medial malleolus evident on CT; and 5) injury to the articular surface of the distal tibia and vault collapse (Fig. 3 ).These features are not common in traditional rotational ankle fractures, but their important contribution to collapse is often ignored in clinical practice [ 6 , 7 , 15 ]. There is no accurate name for a type of fracture that involves the impaction of a medial triangular fragment on the lateral articular surface of the tibia.…”

Section: Discussionmentioning

confidence: 99%

“…The talus impacts the medial plate of the tibia to cause oblique, oblique inward upward or vertical upward fractures combined with bone compression, collapse, or cartilage surface damage to the ankle vault due to serious damage to the ankle [ 5 ]. If the injury is not accurately diagnosed and treated with open anatomical reduction and internal fixation, loss of joint integrity may occur, resulting in severe traumatic sequelae, permanent ankle pain and greatly reduced quality of life [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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A comparative study of the clinical efficacy of supination-adduction type II ankle fracture surgery based on the medial pilon fracture concept versus the ankle fracture concept

Zhan

Zhu

et al. 2021

BMC Musculoskelet Disord

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Background A supination-adduction (SAD) ankle fracture is a special type of ankle fracture that results in collapse of the distal tibial articular surface; as such, orthopaedic surgeons require greater awareness of this type of fracture. The severity of this injury lies between that of an ordinary ankle fracture and a pilon fracture, and the treatment of such fractures based on the ankle fracture concept leads to extremely high rates of postoperative complications and a poor prognosis. In this retrospective study, we aimed to explore the treatment of SAD fractures based on the pilon fracture concept. Methods We retrospectively analysed the clinical data of 67 patients with Lauge-Hansen supination-adduction type II (SAD-II) ankle fractures, most of whom had a 44-A AO classification. Patients underwent surgical treatment at the Second Affiliated Hospital of Anhui Medical University from January 2009 to June 2019. The patients were divided into two groups based on the surgical concept employed: 43 patients were included in the ankle fracture surgical concept group, and 24 patients were included in the medial pilon fracture surgical concept group. The therapeutic effect was evaluated based on the Burwell-Charnley radiological reduction standard, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and postoperative visual analogue scale (VAS) pain score 1 year after surgery using regression with adjustment for confounding factors. Results All 67 patients were followed up. Twenty-four patients were treated according to the medial pilon fracture concept, and forty-three patients were treated according to the ankle fracture concept. The AOFAS score 1 year after surgery in the medial pilon group (89.83 ± 2.77) was higher than that in the ankle fracture group (83.63 ± 7.97) (p < 0.05). The VAS score 1 year after surgery in the medial pilon fracture group (1.17 ± 0.96) was significantly better than that in the ankle fracture group (2.28 ± 0.96) (p < 0.05). Conclusion Patients with Lauge-Hansen SAD-II ankle fractures treated based on the medial pilon fracture surgical concept had better postoperative outcomes than those treated based on the ankle fracture surgical concept. Level of evidence Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A comparative study of the clinical efficacy of supination-adduction type II ankle fracture surgery based on the medial pilon fracture concept versus the ankle fracture concept

Zhan

Zhu

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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“…Supination-adduction (SA) fractures at stage II involve vertical or oblique fragmentation of the medial malleolus; although there is a high frequency of concurrent medial plafond involvement, estimated at 42% to 61% in stage II supination-adduction injuries, posterior malleolar fractures rarely occur. 1,43 A high-energy stage III supination–external rotation injury translates into the posterior aspect of the medial malleolar structures, causing either the PITFL to rupture or a posterior malleolar avulsion fracture to occur. Pronated-external rotation initially involves disruption of the deltoid ligament complex or medial malleolar fracture (stage I); further force may result in disruption of the anterior and posterior inferior tibiofibular ligaments or posterior malleolar avulsion fracture (stage II).…”

Section: Anatomy and Pathomechanicsmentioning

confidence: 99%

“…It is estimated that posterior malleolar fractures are found in 40% of rotational ankle fractures, but they may also occur in isolation, as a component of pilon fractures, or as a component of a distal tibia fracture. 1,6,31,33 These fractures involve both the weight-bearing portion of the tibial plafond and the ankle syndesmosis, thus affecting tibiotalar load transfer, as well as posterior talar and rotatory ankle stability. 3,46,49 Recent attention has focused on the workup and management of this heterogenous group of fractures and their relationship to ankle and distal tibia fracture outcomes.…”

Section: Introductionmentioning

confidence: 99%

Anatomy, Classification, and Management of Ankle Fractures Involving the Posterior Malleolar Fragment: A Literature Review

Bergman

Morin

Lawson

2019

Foot & Ankle Orthopaedics

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The posterior malleolar fragment is frequently involved in rotational ankle fractures, but diagnosis and definitive management remains controversial. Ankle fractures with a posterior malleolar component that are not identified and treated in a timely manner may contribute significantly to future comorbidities, including continued pain, instability, and the development of arthritis. This article highlights the anatomic features of posterior malleolar ankle fractures, the classification schemes used, and discusses the various nonsurgical and surgical methods currently used. Level of Evidence: Level V, expert opinion.

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“…The incidence of clinically meaningful articular impaction in SAD type II ankle fractures is largely unknown, although one recent series reports that impaction was noted intraoperatively half of the time and operatively addressed in 84% of these patients. 1,8,16 Furthermore, the influence of articular impaction and reduction quality on posttraumatic arthrosis remains understudied in these injuries. In a prior study, we reported that treatment failure was more common in pilon fractures compared with SAD ankle injuries and introduced the importance of anatomic restoration of the articular surface to optimize outcomes in these patients.…”

Section: Introductionmentioning

confidence: 99%

Plafond Malreduction and Talar Dome Impaction Accelerates Arthrosis After Supination-Adduction Ankle Fracture

et al. 2021

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Background: Supination-adduction (SAD) type II ankle fractures can have medial tibial plafond and talar body impaction. Factors associated with the development of posttraumatic arthritis can be intrinsic to the injury pattern or mitigated by the surgeon. We hypothesize that plafond malreducton and talar body impaction is associated with early posttraumatic arthrosis. Methods: A retrospective cohort of skeletally mature patients with SAD ankle fractures at 2 level 1 academic trauma centers who underwent operative fixation were identified. Patients with a minimum of 1-year follow-up were included. The presence of articular impaction identified on CT scan was recorded and the quality of reduction on final intraoperative radiographs was assessed. The primary outcome was radiographic ankle arthrosis (Kellgren-Lawrence 3 or 4), and postoperative complications were documented. Results: A total of 175 SAD ankle fractures were identified during a 10-year period; 79 patients with 1-year follow-up met inclusion criteria. The majority of injuries resulted from a high-energy mechanism. Articular impaction was present in 73% of injuries, and 23% of all patients had radiographic arthrosis (Kellgren-Lawrence 3 or 4) at final follow-up. Articular malreduction, defined by either a gap or step >2 mm, was significantly associated with development of arthrosis. Early treatment failure, infection, and nonunion was rare in this series. Conclusion: Malreduction of articular impaction in SAD ankle fractures is associated with early posttraumatic arthrosis. Recognition and anatomic restoration with stable fixation of articular impaction appears to mitigate risk of posttraumatic arthrosis. Investigations correlating postoperative and long-term radiographic findings to patient-reported outcomes after operative treatment of SAD ankle fractures are warranted. Level of Evidence: Level IV, retrospective case series.

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Radiographic Detection of Marginal Impaction in Supination-Adduction Ankle Fractures

Abstract: Level III, comparative series.

Cited by 12 publications

References 15 publications

A comparative study of the clinical efficacy of supination-adduction type II ankle fracture surgery based on the medial pilon fracture concept versus the ankle fracture concept

A comparative study of the clinical efficacy of supination-adduction type II ankle fracture surgery based on the medial pilon fracture concept versus the ankle fracture concept

Anatomy, Classification, and Management of Ankle Fractures Involving the Posterior Malleolar Fragment: A Literature Review

Plafond Malreduction and Talar Dome Impaction Accelerates Arthrosis After Supination-Adduction Ankle Fracture

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