Supination trauma. A classic case

Area of Science:

• Orthopedics
• Sports Medicine
• Biomechanics

Background:

• Lateral ankle ligament sprains are the most frequent ligamentous injuries globally.
• The primary mechanism involves foot supination, leading to antero-lateral rotational instability (ALRI).
• Current classification systems (mild, moderate, severe) may lack practical clinical differentiation.

Purpose of the Study:

• To emphasize the clinical relevance of distinguishing between ligament elongation and complete rupture in ankle sprains.
• To highlight the biomechanical consequences of lateral ligamentous trauma, specifically ALRI.
• To advocate for a comprehensive clinical examination beyond the distal fibula.

Main Methods:

• Retrospective clinical study analysis (Zwipp, 1235 patients).
• Review of common ligamentous and bony structures involved in ankle sprains.
• Emphasis on clinical examination protocols and diagnostic imaging.

Main Results:

• Complete disruptions frequently involve anterior talo-navicular and fibulo-calcaneal ligaments (70%).
• Syndesmotic injuries occur in up to 10% of ankle sprains; deltoid ligament injuries in 2.5%.
• Associated injuries along the 'supination fracture line' are reported in 7.4% of cases.

Conclusions:

• Clinical assessment must include screening of the fifth metatarsal base, calcaneo-cuboideal ligament, anterior calcaneal process ligaments, talus, and syndesmotic ligaments.
• Careful clinical examination and standard two-plane radiographs are deemed sufficient for diagnosing ankle sprains.
• Accurate diagnosis facilitates appropriate functional therapy for optimal recovery.