Do Undisplaced Stable Ankle Fractures Ever Displace – Are We Subjecting Our Patients To Unnecessary Radiation And Follow-Up Appointments?

摘要

AIM: The aim of this study is to assess whether stable undisplaced ankle fractures treated conservatively with a below knee non weight bearing cast ever displace. METHODS: Retrospective case notes analysis was performed. Between August 2007 and August 2009, one hundred and twenty one patients sustained a stable undisplaced ankle fracture which was treated conservatively. Their age range was from 16 to 86 years (mean 53 years). Male to female ratio was 74:47. The mean number of clinic follow ups was 3.7. These patients were classified according to the Danis-Weber Classification for analysis. Thirty (25%) patients had Weber A1 fractures, seventy two (60%) had Weber B1 fractures, five patients (4%) had Weber B2 fractures, three patients (2%) had Weber C1 fractures, ten patients (8%) had isolated medial malleolus fracture and one patient suffered an isolated posterior malleolus fracture. RESULTS: An average of 4.7 radiographs were performed on each patient from the time of diagnosis to discharge from clinic. None of these fractures displaced on follow up radiographs. CONCLUSION: Stable undisplaced ankle fractures treated conservatively with a below knee non weight bearing cast do not displace. Introduction Ankle fracture is one of the most common of bone and joint fractures. Stable ankle fractures compromise 40 – 75% of this group1,2,3. The incidence of ankle fractures is approximately 187 fractures per 100,000 people each year4. Most ankle fractures are malleolar fractures. 60 to 70 percent occur as unimalleolar fractures, 15 to 20 percent as bimalleolar fractures, and 7 to 12 percent as trimalleolar fractures1,2.The medial ankle ligament complex consists of the deep and superficial fibers of the deltoid ligament. The medial ligament is stronger than the lateral ligaments. The lateral ligament consists of three bands which are the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament5. The peroneal tendons, anterior and posterior tibialis tendons, Achilles tendon, and joint capsule provide additional stability.The syndesmosis of the ankle refers to the articulation of the distal tibia and fibula. Stability is provided by the anterior tibiofibular ligament, the posterior tibiofibular ligament, the transverse tibiofibular ligament (posteriorly), and the interosseous membrane, which extends from the ankle proximally. These structures strengthen the mortise and prevent the distal tibia and fibula from separating (diastasis). Movements that occur at the ankle joint are plantarflexion and dorsiflexion whereas inversion and eversion occurs at the subtalar joint. Classifications used in ankle fractures are AO classification, Lauge Hansen classification and the Danis – Weber classification. The simplest and most commonly used classification is the Danis – Weber classification (Figure 1).