A New Interpretation of the Mechanism of Ankle Fracture

Haraguchi, Naoki; Armiger, Robert S.
April 2009
Journal of Bone & Joint Surgery, American Volume;Apr2009, Vol. 91-A Issue 4, p821
Academic Journal
Background: Researchers have found it difficult to recreate a Lauge-Hansen supination-external rotation-type ankle fracture in experimental settings. We hypothesized that a pronation-external rotation mechanism could cause both distal, short oblique and high fibular fractures and that the fracture type would be affected by associated, laterally directed forces applied to the foot. Methlods: Twenty-three cadaver ankles were subjected to fracture loading that replicated the Lauge-Hansen pronation- external rotation mechanism with or without applying an external lateral force. In Phase I, an axial load was applied to fifteen specimens mounted on a materials testing machine. Each foot was rotated externally to failure. In Phase II, eight specimens were tested according to the Phase-I protocol, but external forces were applied laterally at the foot to increase the abduction moment at the ankle. Load and position versus time curves were recorded and were correlated with video image data to establish the sequence of failure of specific anatomic structures. Results: Eight specimens tested in Phase I sustained an oblique fracture of the distal end of the fibula with both medial and posterior injuries that occurred after the fibular fracture. Increasing the external lateral force and hence the abduction moment within the ankle (Phase II) resulted in three of eight specimens sustaining a high fibular fracture with a reversed fracture line (anterosuperior to posteroinferior) and/or a comminuted high fibular fracture. The distribution of traditional pronation-external rotation-type fractures differed significantly between Phase I and Phase II (p = 0.032). Conclusions: This study generated counterexamples to the Lauge-Hansen classification system by showing that a short oblique fracture of the distal end of the fibula can occur with the foot in the pronated position. Furthermore, a high fibular fracture was recreated by increasing the abduction moment at the ankle. Clinical Relevance: The pattern of ankle fracture is related directly to the applied loads, including specifically the combination of the external rotational moment and the abduction moment. The results of the current study could provide the basis for a more straightforward classification of ankle fractures based on applied loads.


Related Articles

  • Realignment-lengthening osteotomy for malunited distal fibular fracture. El-Rosasy, Mahmoud; Ali, Tarek // International Orthopaedics;Jul2013, Vol. 37 Issue 7, p1285 

    Purpose: Persistent displacement of ankle fractures increases the stresses on the articular cartilage and leads to degenerative arthritis. Correction of the ankle mortise restores the normal ankle biomechanics and should prevent the development of degenerative joint disease. Methods: Seventeen...

  • Stabilisation of the fractured fibula plays an important role in the treatment of pilon fractures: a retrospective comparison of fibular fixation methods. Shu-Wen Chen; Shih-Hao Chen; Wen-Chiao Chen; Ming-Jye Lau; Tzu-Liang Hsu // International Orthopaedics;Jun2009, Vol. 33 Issue 3, p695 

    Abstract  Ninety-eight pilon fractures associated with ipsilateral distal fibular fracture were included in this study. The pilon fractures were treated by open reduction and plating. The 98 fractures were divided into three groups based on the treatment method of fractured fibula. Group A...

  • Distal Tibial Reconstruction with Use of a Circular External Fixator and an Intramedullary Nail. Eralp, Levent; Kocaoglu, Mehmet // Journal of Bone & Joint Surgery, American Volume;Oct2008 Supplement 2, Vol. 90-A, p181 

    BACKGROUND: Distal tibial reconstruction with use of an external fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an intramedullary nail has been...

  • Thoracolumbar Burst Fractures Treated with Posterior Decompression and Pedicle Screw Instrumentation Supplemented with Balloon-Assisted Vertebroplasty and Calcium Phosphate Reconstruction. Marco, Rex A. W.; Kushwaha, Vivek P. // Journal of Bone & Joint Surgery, American Volume;Jan2009, Vol. 91-A Issue 1, p20 

    Background: The treatment of unstable thoracolumbar burst fractures with short-segment posterior spinal instrumentation without anterior column reconstruction is associated with a high rate of screw breakage and progressive loss of reduction. The purpose of the present study was to evaluate the...

  • Operative Management of Distal Radial Fractures with 2.4-Millimeter Locking Plates: A Multicenter Prospective Case Series. Jupiter, Jesse B.; Marent-Huber, M. // Journal of Bone & Joint Surgery, American Volume;Jan2009, Vol. 91-A Issue 1, p55 

    Background: In the past decade, there has been a trend toward open reduction and internal fixation of unstable distal radial fractures. There are now more than thirty different implant designs specific for the fixation of distal radial fractures. A multicenter prospective study of a case series...

  • Fractures of the Lesser Tuberosity of the Humerus. Robinson, C. Michael; Teoh, Kar H.; Baker, Alex; Bell, Lawrence // Journal of Bone & Joint Surgery, American Volume;Mar2009, Vol. 91-A Issue 3, p512 

    Background: Fractures of the lesser tuberosity are rare injuries, and little is known of their epidemiology. Operative treatment is generally recommended for displaced fractures; however, the outcome of this method of treatment has not previously been studied. The aims of our study were to...

  • Open Reduction and Internal Fixation of Capitellar Fractures with Headless Screws. Ruchelsman, David E.; Tejwani, Nirmal C.; Kwon, Young W.; Egol, Kenneth A. // Journal of Bone & Joint Surgery, American Volume;Mar2009 Supplement, Vol. 91-A, p38 

    BACKGROUND: The outcome of operatively treated capitellar fractures has not been reported frequently. The purpose of the present study was to evaluate the clinical, radiographic, and functional outcomes following open reduction and internal fixation of capitellar fractures that were treated with...

  • Screw Fixation Compared with Suture-Button Fixation of Isolated Lisfranc Ligament Injuries. Panchbhavi, Vinod K.; Vallurupalli, Santaram; Jinping Yang; Andersen, Clark R. // Journal of Bone & Joint Surgery, American Volume;May2009, Vol. 91-A Issue 5, p1143 

    Background: A cannulated screw is currently used to reduce and stabilize diastasis at the Lisfranc joint. The screw requires removal and may break in situ. A suture button does not have these disadvantages, but it is not known if it can provide stability similar to that provided by a cannulated...

  • Volar Locked Plating Improved Wrist Range of Movement More Than External Fixation for Distal Radial Fracture. Egol, K.; Walsh, M.; Tejwani, N.; McLaurin, T.; Wynn, C.; Paksima, N.; Ring, David // Journal of Bone & Joint Surgery, American Volume;May2009, Vol. 91-A Issue 5, p1280 

    The article reports on the results of research which was conducted in an effort to determine how bridging external fixation compared with locked volar plate and screw fixation in patients with displaced fracture of the distal part of the radius. Researchers conducted a randomized, unblinded...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics