The effect of different methods of stability assessment on fixation rate and complications in supination external rotation (SER) 2/4 ankle fractures.
BACKGROUND
Distinguishing stable supination-external rotation (SER) 2 from unstable SER 4 ankle fractures, using standard radiographs, is controversial. Examination under anaesthesia (EUA), gravity-stress (GS) and weight-bearing (WB) radiographs can aid surgical decision-making. We evaluated the effect of three methods of fracture stability assessment.


METHODS
Radiographs and case-notes of 312 consecutive patients with SER 2/4 fractures were reviewed. We recorded ankle stability assessment (plain film (PF) and EUA vs. GS vs. WB radiographs), management (conservative vs. operative), unplanned surgery and complications.


RESULTS
Forty five percent assessed with GS underwent surgery (6% for PF/EUA, 4% for WB; P=0.0001). Amongst GS patients, 11% underwent additional surgery (0.1% PF/EUA, 0% WB; P=0.0001). Complications occurred in 2% of the WB group (8% for PF/EUA, 22% for GS; P=0.007).


CONCLUSIONS
This study associates GS assessment with higher rates of surgery and complications. Subsequent studies may determine the longer term effect stability assessments have on post-traumatic arthritis.
Directorate of Trauma and Orthopaedics, Frimley Park Hospital, Camberley, Surrey GU167UJ, United Kingdom. Electronic address: edwarddawe@doctors.org.uk.
Edward J C
EJ
Dawe
Directorate of Trauma and Orthopaedics, Frimley Park Hospital, Camberley, Surrey GU167UJ, United Kingdom.
Roozbeh
R
Shafafy
Directorate of Trauma and Orthopaedics, Frimley Park Hospital, Camberley, Surrey GU167UJ, United Kingdom.
Jonathan
J
Quayle
Directorate of Trauma and Orthopaedics, Frimley Park Hospital, Camberley, Surrey GU167UJ, United Kingdom.
Nikolaos
N
Gougoulias
Directorate of Trauma and Orthopaedics, Frimley Park Hospital, Camberley, Surrey GU167UJ, United Kingdom.
Alexander
A
Wee
Directorate of Trauma and Orthopaedics, Frimley Park Hospital, Camberley, Surrey GU167UJ, United Kingdom.
Anthony
A
Sakellariou
D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005592:Fracture Fixation; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012399:Rotation; D013484:Supination; D016474:Weight-Bearing
Ankle fracture; Gravity stress; Stability; Stress view; Weight-bearing