Medial insufficiency in postoperative weight-bearing radiographs in supination-external rotation type 4 bimalleolar ankle fractures: is the Lauge-Hansen classification insufficient in predicting medial soft tissue damage?

Authors : Ali YÜCE, Mustafa YERLİ, Tahsin Olgun BAYRAKTAR, Bulent KARSLIOGLU, Yunus İMREN, Süleyman Semih DEDEOĞLU, Mustafa Çağlar KIR, Hakan GÜRBÜZ

Pages : 465-471

Doi:10.18621/eurj.796614

View : 21 | Download : 10

Publication Date : 2021-09-04

Article Type : Research Paper

Abstract :Objectives: According to the Lauge-Hansen classification, supination external-rotation insert ignore into journalissuearticles values(SER); type 4 fractures should be accompanied by medial malleolar fracture or deltoid ligament injury. The aim of the study was to investigate medial insufficiency rates in postoperative weight-bearing radiographs in SER type 4 bimalleolar fractures. Methods: The files of the patients who were operated with the diagnosis of SER type 4 bimalleolar ankle fracture between 2017-2020 were evaluated retrospectively. Thirty-seven cases insert ignore into journalissuearticles values(15 males and 22 females); were included in the study. The data based on the evaluation of the weight-bearing radiographs of the patients taken in the postoperative 1st year were examined statistically. Results: The injury mechanism was sports injury in 17 insert ignore into journalissuearticles values(45.9%); cases, traffic accidents in 8 insert ignore into journalissuearticles values(21.6%); cases, falling in 9 insert ignore into journalissuearticles values(24.3%); cases, and falling from height in 3 insert ignore into journalissuearticles values(8.2%); cases. The preoperative tibiofibular distance was 6.05 ± 1.86 mm, and the postoperative tibiofibular distance was 4.19 ± 0.40 mm insert ignore into journalissuearticles values( p = 0.001);. The preoperative tibiofibular overlap was 5.03 ± 2.93 mm, and the postoperative tibiofibular overlap was 8.62 ± 1.04 mm insert ignore into journalissuearticles values( p = 0.001);. The postoperative medial clear space was 4.11 ± 0.57 mm. Postoperative medial clear space of 5 mm and higher was determined in 7 insert ignore into journalissuearticles values(18.9%); cases. Conclusions: In SER type 4 bimalleolar fractures with a large medial malleolar fragment fracture, weight-bearing radiographs may show an increase in medial clear space. This means that a medial malleolar fracture in bimalleolar fractures may be also accompanied by deltoid ligament injury. The Lauge-Hansen classification system may be insufficient to identify a medial ligament injury.
Keywords : bimalleol, fracture, supination external rotation, Lauge Hansen, deltoid ligament