Patterns of Ankle Fractures Based on Radiographs and CT Images of 1000 Consecutive Patients

Document Type : RESEARCH PAPER

Authors

1 Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

3 Shiraz University of Medical Sciences, Shiraz, Iran

4 1 Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran - 4 Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Objectives: The knowledge of different types of ankle fractures based on plain radiographs and 
computed tomography (CT) images can help improve patients' management.
Methods: This cross-sectional study assessed the plain radiographs and CT images of 1,000 consecutive patients 
observed in an emergency department between March 2015 and March 2020. Fractures were labeled as uni-, bi-, 
or trimalleolar. Malleolar fractures were classified into medial, lateral, and posterior ones based on Herscovici, DanisWeber, and Mason and Molloy classifications, respectively. Bi- and trimalleolar fractures, on the other hand, were 
categorized according to the Lauge-Hansen classification.
Results: This study included 1,000 patients with 1,003 ankle fractures. Of them, 901 were adults (mean±SD age: 
41.6±16.7, male: 567 [62.9%]) with 904 fractures. In total, 53% of adult patients were 18 to 39 years old. Considering 
unilateral ankle fractures, the medial malleolar fracture was the most common unimalleolar fracture (62.6%), with 
Herscovici C being the most frequent subtype (65.3%). On the other hand, the most common type of lateral malleolar 
fracture was Danis-Weber type B (65.5%). There were also 209 (23.3%) bimalleolar and 114 (12.7%) trimalleolar 
fractures, 5.8% (16 fractures) of which could not be classified based on the Lauge-Hansen classification. 
Unimalleolar fractures were also observed in 87 (87.9%) children, with the medial malleolar fracture being the most 
common type (89.7%).
Conclusion: Medial malleolar fractures were the most frequent malleoli in patients observed in the emergency 
department under study. Among bi- and trimalleolar ankle fractures, supination-external rotation and pronationexternal rotation injuries were the most common patterns. The Lauge-Hansen classification was not applicable in 
5.8% of bi- and trimalleolar fractures.
 Level of evidence: IV

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