Radiographic classification of ankle injuries

Area of Science:

• Orthopedics
• Radiology
• Biomechanics

Background:

• Ankle injuries are common, often involving complex fractures.
• Accurate classification of ankle fractures is crucial for effective treatment.
• The Lauge-Hansen system is a widely used method for classifying ankle injuries based on mechanism.

Purpose of the Study:

• To evaluate the accuracy of initial ankle radiographs in predicting the total extent of ankle injury.
• To correlate specific fracture patterns with injury mechanisms using the Lauge-Hansen system.

Main Methods:

• Retrospective review of initial ankle radiographs from 144 patients with ankle injuries.
• Classification of injuries using the Lauge-Hansen system based on operative, clinical, and radiographic findings.
• Analysis of fracture patterns (lateral and medial malleolar) and their association with injury mechanisms.

Main Results:

• Three distinct lateral malleolar fracture patterns were identified, each unique to specific injury mechanisms: transverse (supination-adduction), spiral (supination-lateral rotation), and bending (pronation-abduction).
• Vertical medial malleolar fractures were exclusively associated with supination-adduction injuries.
• Radiographs accurately determined the complete extent of injury in all but four patients, where deltoid ligament tears were not predicted.

Conclusions:

• Initial ankle radiographs are highly accurate in predicting the extent of ankle injuries.
• Specific malleolar fracture patterns reliably indicate the underlying injury mechanism.
• Radiographic assessment may not consistently detect associated deltoid ligament tears.