title: Malleolar fractures and their ligamentous injury equivalents have similar outcomes in supination-external rotation type IV fractures of the ankle treated by anatomical internal fixation.
abstract: It has previously been suggested that among unstable   ankle fractures, the presence of a malleolar fracture is associated   with a worse outcome than a corresponding ligamentous injury. However,   previous studies have included heterogeneous groups of injury. The   purpose of this study was to determine whether any specific pattern of   bony and/or ligamentous injury among a series of supination-external   rotation type IV (SER IV) ankle fractures treated with anatomical   fixation was associated with a worse outcome. We analysed a prospective cohort of 108 SER IV ankle fractures   with a follow-up of one year. Pre-operative radiographs and MRIs   were undertaken to characterise precisely the pattern of injury.   Operative treatment included fixation of all malleolar fractures.   Post-operative CT was used to assess reduction. The primary and   secondary outcome measures were the Foot and Ankle Outcome Score   (FAOS) and the range of movement of the ankle. There were no clinically relevant differences between the four   possible SER IV fracture pattern groups with regard to the FAOS   or range of movement. In this population of strictly defined SER   IV ankle injuries, the presence of a malleolar fracture was not   associated with a significantly worse clinical outcome than its   ligamentous injury counterpart. Other factors inherent to the injury   and treatment may play a more important role in predicting outcome.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021, USA. berkesm@hss.edu
authors.forename: M B
authors.initials: MB
authors.lastname: Berkes
authors.forename: M T M
authors.initials: MT
authors.lastname: Little
authors.forename: L E
authors.initials: LE
authors.lastname: Lazaro
authors.forename: P K
authors.initials: PK
authors.lastname: Sculco
authors.forename: R M
authors.initials: RM
authors.lastname: Cymerman
authors.forename: M
authors.initials: M
authors.lastname: Daigl
authors.forename: D L
authors.initials: DL
authors.lastname: Helfet
authors.forename: D G
authors.initials: DG
authors.lastname: Lorich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008022:Ligaments / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008307:Malleus / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012399:Rotation; D013484:Supination; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult