Department of Orthopaedic Surgery, University of Bern, Inselspital, 3010 Bern, Switzerland.
Arch Orthop Trauma Surg. 2010 May;130(5):693-8. doi: 10.1007/s00402-010-1051-1. Epub 2010 Jan 16.
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.
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).
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".
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.
孤立的外踝骨折通常由旋后外旋（SER）损伤引起，可能包括三角韧带断裂。手术治疗的必要性基于对相关内侧软组织破坏的认识。目前用于评估踝关节稳定性的测试包括手动应力射线照片和重力应力射线照片，但似乎高估了骨折固定的必要性。
我们研究了在 57 例由 SER 机制引起的稳定和不稳定的孤立外踝骨折患者中使用负重射线照片来区分的方法。稳定骨折患者（根据 Lauge-Hansen 分类为 SER Ⅱ型）采用不同的外部支撑进行非手术治疗。47 例患者通过问卷调查和 AOFAS 踝关节后足评分进行评估。随访时间为 18-120 个月（平均 62 个月）。
57 例患者中有 51 例（90%）发现为稳定骨折（SER Ⅱ型）并接受非手术治疗。末次随访时 AOFAS 评分为 96.1 分（85-100 分）。4 例患者报告有轻微不适。发现危险因素（如吸烟）与骨折愈合延迟有“中度”相关性，而外部支撑（如绷带、石膏）与 AOFAS 评分和骨折愈合延迟的相关性为“差”。
使用负重射线照片是一种简单、无痛苦、安全可靠的方法，可以排除手术治疗的需要，在大多数患者的临床结果在随访中表现出色。从决定手术治疗到实际手术的 3-10 天延迟时间被患者很好地接受。
