Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education, Prof. Adam Gruca Clinical Hospital, Konarskiego Str. 13, 05-400 Otwock, Poland.
Forensic Medicine Department, Medical University of Warsaw, Wojciecha Oczki Str. 1, 00-001 Warsaw, Poland.
Forensic Sci Int. 2018 Oct;291:185-192. doi: 10.1016/j.forsciint.2018.08.042. Epub 2018 Sep 5.
The genetic Lauge-Hansen classification has been traditionally used for reconstruction of the mechanism of ankle injury. The ability of the Lauge-Hansen classification to predict actual mechanism of the injury has been questioned in recent studies, leaving a void in medicolegal reasoning. The aim of this study is to identify morphologic features of malleolar fractures on plain X-rays that may be used to reveal the fracture mechanism.
Radiographs of 78 patients with acute malleolar fractures were analyzed and compared with fracture mechanisms reported by these patients.
A modified Pankovich classification of medial malleolus fractures and the presence of a posterior malleolus fracture were able to significantly predict the mechanism of fracture reported by the patient (p<0.05). Lateral fracture morphology was not useful for predicting the fracture mechanism except for infrasyndesmotic fractures pointing to a supination mechanism.
A supination mechanism of the fracture can be predicted by observing pure ligamentous or chip-avulsion deltoid injury. The presence of an anterior colliculus fracture of the medial malleolus is correlated with a pronation mechanism. A fracture of the posterior malleolus correlates with pronation while an intact posterior malleolus correlateds with supination as a fracture mechanism. Absolute determination of fracture mechanism from the X-ray morphology of the fracture is impossible in the majority of cases.
传统上，Lauge-Hansen 遗传分类法被用于重建踝关节损伤的机制。最近的研究质疑 Lauge-Hansen 分类法预测损伤实际机制的能力，这在医学法律推理中留下了空白。本研究旨在确定 X 线平片上的外踝骨折的形态特征，这些特征可能用于揭示骨折机制。
分析了 78 例急性外踝骨折患者的 X 光片，并将其与这些患者报告的骨折机制进行比较。
改良的 Pankovich 内侧外踝骨折分类法和后踝骨折的存在能够显著预测患者报告的骨折机制（p<0.05）。除了指向旋后机制的下胫腓联合下骨折外，外侧骨折形态对预测骨折机制没有帮助。
通过观察单纯的韧带或撕脱三角骨损伤，可以预测旋后机制的骨折。内侧外踝前丘骨折与旋前机制相关。后踝骨折与旋前相关，而完整的后踝与旋后机制相关。在大多数情况下，从骨折的 X 线形态不可能确定骨折机制的绝对确定。
