title: The use of weightbearing radiographs to assess the stability   of supination-external rotation fractures of the ankle.
abstract: BACKGROUND
  Isolated lateral malleolar fractures usually result from a supination-external rotation (SER) injury and may include a deltoid ligament rupture. The necessity of operative treatment is based on the recognition of a relevant medial soft-tissue disruption. Currently used tests to assess ankle stability include manual stress radiographs and gravity stress radiographs, but seem to overestimate the need for fracture fixation.
  
  
  METHODS
  We investigated the use of weightbearing radiographs to distinguish stable and unstable isolated lateral malleolar fractures induced by the SER mechanism in 57 patients. Patients with stable fractures (SER type II according to the Lauge-Hansen classification) were treated non-operatively with varying external support. Forty-seven patients were evaluated by questionnaire and AOFAS ankle-hindfoot score. Follow-up was 18-120 months (mean 62).
  
  
  RESULTS
  Fifty-one of fifty-seven (90%) patients were found to have stable fractures (SER type II) and were treated nonoperatively. The AOFAS score was 96.1 points on average (range 85-100) at latest follow-up. Four patients reported minor complaints. A "moderate" correlation of risk factors (i.e. smoking) to delayed bone healing was found while the correlation of varying external support (i.e. bandage, cast) to the AOFAS score and delayed bone healing was "poor".
  
  
  CONCLUSIONS
  The use of weightbearing radiographs is an easy, pain-free, safe and reliable method to exclude the need for operative treatment, with excellent clinical outcome in the majority of the patients seen at latest follow-up. The delay of 3-10 days until the decision about surgical treatment is well accepted by the patients.
authors.affiliation: Department of Orthopaedic Surgery, University of Bern, Inselspital, 3010 Bern, Switzerland. martin.weber@insel.ch
authors.forename: Martin
authors.initials: M
authors.lastname: Weber
authors.forename: Helge
authors.initials: H
authors.lastname: Burmeister
authors.forename: Gerhard
authors.initials: G
authors.lastname: Flueckiger
authors.forename: Fabian G
authors.initials: FG
authors.lastname: Krause
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D000843:Ankle Joint / Q000503:physiopathology; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016474:Weight-Bearing