X-ray features to predict ankle fracture mechanism

Area of Science:

• Orthopedic surgery
• Radiology
• Forensic medicine

Background:

• The Lauge-Hansen classification, traditionally used for ankle injury reconstruction, has faced scrutiny regarding its predictive accuracy for actual injury mechanisms.
• This uncertainty creates a gap in medicolegal assessments of ankle trauma.
• Identifying reliable radiographic indicators for fracture mechanisms is therefore essential.

Purpose of the Study:

• To investigate specific morphologic features on plain X-rays that can predict the mechanism of malleolar fractures.
• To address the limitations of existing classification systems in determining injury causation.

Main Methods:

• Analysis of radiographs from 78 patients with acute malleolar fractures.
• Comparison of radiographic findings with patient-reported fracture mechanisms.

Main Results:

• A modified Pankovich classification for medial malleolus fractures and the presence of a posterior malleolus fracture significantly predicted the reported injury mechanism (p<0.05).
• Lateral fracture morphology was generally unhelpful, except for infrasyndesmotic fractures suggesting a supination mechanism.
• Pure ligamentous or chip-avulsion deltoid injuries indicated supination; anterior colliculus fractures suggested pronation.

Conclusions:

• Radiographic features, including medial malleolus fracture patterns (anterior colliculus for pronation, intact posterior for supination) and posterior malleolus fractures (indicating pronation), offer predictive value for ankle injury mechanisms.
• While certain X-ray findings correlate with supination or pronation, absolute determination of the fracture mechanism from morphology alone is not consistently possible.