title: Foot and ankle fractures at the supination line.
abstract: BACKGROUND
  The supination line is a fictive line along the foot and ankle, on which over twenty fracture types and approximately ten different ligamentous sprain-injuries have been identified.
  
  
  OBJECTIVE
  The current study was conducted to evaluate the incidence of different types of supination line injuries visible at the initial radiographs at the Emergency Department and to determine the type and percentage of misdiagnosed injuries.
  
  
  METHODS
  Retrospective study of consecutive patients who visited the Emergency Department, between January 1 and June 30, 2009, after sustaining an injury of the foot or ankle and had a radiograph taken within 24 h of the incident.
  
  
  RESULTS
  In the 6-month study period 1284 patients were included. In these cases the trauma mechanism was a sprain in 780 patients (60.7%). Of these patients 310 suffered from a fracture (40%). There were 36 (4.6%) false-positive cases and in 91 (11.7%) cases the initial diagnosis was false-negative. The number with a missed fracture expressed as a percentage of all patients with a fracture was 29.4% (91/310).
  
  
  CONCLUSIONS
  Detection of injuries along the supination line remains difficult. This study might aid in decreasing the number of misdiagnosed injuries, which is of value as these might negatively affect outcome.
authors.affiliation: Department of Surgery and Traumatology, Reinier de Graaf Groep Delft, The Netherlands. timschepers@hotmail.com
authors.forename: Tim
authors.initials: T
authors.lastname: Schepers
authors.forename: Esther M
authors.initials: EM
authors.lastname: van Schie-van der Weert
authors.forename: Mark R
authors.initials: MR
authors.lastname: de Vries
authors.forename: Maarten
authors.initials: M
authors.lastname: van der Elst
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000175:diagnosis / Q000453:epidemiology*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D018409:Foot Injuries / Q000175:diagnosis / Q000453:epidemiology*; D050723:Fractures, Bone / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D013180:Sprains and Strains / Q000175:diagnosis / Q000453:epidemiology; D013484:Supination