Karanja Alex N, Ho-Huynh Albert, Walsh Tom, Platt Simon R
Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia.
Griffith University, Gold Coast, QLD, Australia.
Foot Ankle Orthop. 2025 Mar 29;10(1):24730114251328694. doi: 10.1177/24730114251328694. eCollection 2025 Jan.
Ankle fractures are common orthopaedic injuries, and their management is primarily determined by fracture stability. The Lauge-Hansen classification system categorizes fractures according to mechanism of injury and ligaments involved. Supination external rotation (SER) type 2 fractures correspond to stable weber B fractures and are traditionally treated nonoperatively, whereas SER 3 and SER 4 fractures, characterized by syndesmosis disruption, typically require surgical intervention. We hypothesize that some apparently stable injuries may involve additional structures, challenging the conventional treatment approach. This study aims to determine the prevalence of SER 3 and SER 4 ankle injuries among radiographically stable SER 2 fractures.
The study used baseline data from a longitudinal cohort conducted at Gold Coast Hospital and Health Service (GCHHS). Patients attending the GCHHS fracture clinic with radiographically stable SER 2 fractures were invited to participate. Those meeting the eligibility criteria underwent ankle magnetic resonance imaging (MRI) to evaluate the integrity of syndesmotic and ankle ligaments.
Fifty-six participants were recruited, 38 (68%) female and 18 (32%) male, with a mean age of 47.2 years. All had stable syndesmoses on radiographic assessment and diagnosed with stable SER 2 ankle fractures. MRI scans revealed that 71% (n = 40) met the criteria for SER 2 injuries, 25% (n = 14) for SER 3 injuries with complete ruptures of posterior inferior tibiofibular ligament (PITFL), and 4% (n = 2) for SER 4 injuries with PITFL and deltoid ligament (DL) ruptures. These results challenge the assumption that radiographically stable SER 2 fractures are consistently stable in terms of additional structures involved.
The study highlights that a considerable proportion of seemingly stable ankle fractures involve more structures than previously thought. This suggests the management of SER 3 and SER 4 injuries could include nonoperative treatment.
Level III, cohort study.
踝关节骨折是常见的骨科损伤，其治疗主要取决于骨折的稳定性。Lauge-Hansen分类系统根据损伤机制和涉及的韧带对骨折进行分类。旋后外旋（SER）2型骨折对应稳定的Weber B型骨折，传统上采用非手术治疗，而以胫腓下联合损伤为特征的SER 3型和SER 4型骨折通常需要手术干预。我们假设一些表面上稳定的损伤可能涉及其他结构，这对传统的治疗方法提出了挑战。本研究旨在确定在影像学上稳定的SER 2型骨折中SER 3型和SER 4型踝关节损伤的患病率。
本研究使用了在黄金海岸医院和卫生服务中心（GCHHS）进行的一项纵向队列研究的基线数据。邀请在GCHHS骨折诊所就诊且影像学上稳定的SER 2型骨折患者参与。符合入选标准的患者接受踝关节磁共振成像（MRI），以评估胫腓下联合和踝关节韧带的完整性。
共招募了56名参与者，其中女性38名（68%），男性18名（32%），平均年龄47.2岁。所有患者在影像学评估中胫腓下联合均稳定，被诊断为稳定的SER 2型踝关节骨折。MRI扫描显示，71%（n = 40）符合SER 2型损伤标准，25%（n = 14）为SER 3型损伤，伴有胫腓后下韧带（PITFL）完全断裂，4%（n = 2）为SER 4型损伤，伴有PITFL和三角韧带（DL）断裂。这些结果挑战了影像学上稳定的SER 2型骨折在涉及的其他结构方面始终稳定的假设。
该研究强调，相当一部分看似稳定的踝关节骨折涉及的结构比以前认为的更多。这表明SER 3型和SER 4型损伤可能包括非手术治疗。
III级，队列研究。
