title: Predictive radiographic markers for concomitant ipsilateral ankle injuries in tibial shaft fractures.
abstract: OBJECTIVE
  To quantify the radiographic tibia and fibula shaft fracture characteristics that are associated with a concomitant ipsilateral ankle injury.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  Academic level I trauma center.
  
  
  METHODS
  Seventy-one adult patients with an operatively treated tibial shaft fracture met the inclusion/exclusion criteria.
  
  
  METHODS
  Preoperative radiographs were categorized according to tibia and fibula fracture pattern, location and spatial relationship to each other. Preoperative computed tomographic scans were then evaluated to assess for the presence of an articular ankle injury.
  
  
  METHODS
  (1) incidence of concomitant tibial shaft fracture and ipsilateral ankle injury; and (2) statistical association between tibia and fibula fracture characteristics in patients with and without an ipsilateral ankle fracture.
  
  
  RESULTS
  Thirty-five of 71 (49.3%) tibial shaft fracture patients had a concomitant ipsilateral ankle injury. Of these, 31 (88.6%) ankle injuries occurred in patients with a spiral pattern tibia fracture of the distal third diaphysis (P < 0.001). A spiral pattern tibia fracture, a distal one-third tibial shaft fracture location, or a spiral pattern fibula fracture all were significantly associated with the presence of an ipsilateral ankle injury (P ≤ 0.001; P = 0.001; and P = 0.002, respectively). Patients with either a transverse pattern or absent fibula fracture, a nonspiral pattern tibia fracture, or a midshaft diaphyseal tibia fracture location were significantly less likely to have an associated ankle injury (P ≤ 0.001; P ≤ 0.001; and P = 0.012, respectively).
  
  
  CONCLUSIONS
  Ipsilateral ankle fractures are commonly associated with tibial shaft fractures, specifically distal one-third spiral type injuries. Recognition of an associated ankle injury is important as it can alter operative and postoperative management. Clinical studies are needed to examine patient outcomes with or without ipsilateral ankle injury to determine the clinical significance of this entity.
  
  
  METHODS
  Prognostic level IV. See instructions for authors for a complete description of levels of evidence.
authors.affiliation: *Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY; †Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Schottel
authors.forename: Marschall B
authors.initials: MB
authors.lastname: Berkes
authors.forename: Milton T M
authors.initials: MT
authors.lastname: Little
authors.forename: Lionel E
authors.initials: LE
authors.lastname: Lazaro
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Nguyen
authors.forename: David L
authors.initials: DL
authors.lastname: Helfet
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging* / Q000293:injuries; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed