Inference on Injury Mechanism of Ankle Fracture by Lauge-Hansen Classification.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose. 7. OTA Int. 2020 Apr 23;3(2):e060. doi: 10.1097/OI9.0000000000000060. eCollection 2020 Jun. Mechanism of posterior malleolar fracture of the ankle: A cadaveric study. Haraguchi N(1), Armiger RS(2). Author information: (1)Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, Asahi-ku, Yokohama, Kanagawa, Japan. (2)Applied Physics Laboratory, The Johns Hopkins University, Laurel, MD. OBJECTIVES: Ankle fracture treatment involves reduction of the bone fragments and stabilization of the joint by reversing the mechanics of injury. For posterior malleolar fracture however, the true mechanism is not understood, leading to a lack of consistent guidance on how to best treat this injury. METHODS: Fifteen cadaver ankles were subjected to fracture loading that replicated the Lauge-Hansen pronation-external rotation mechanism. An axial load was applied to each specimen, which was mounted on a materials testing machine, and the foot was rotated externally to failure. Digital video cameras recorded the failure sequence of specific anatomic structures. RESULTS: Posterior malleolar fracture occurred in 7 specimens. Of these, 1 was an intra-articular fracture, another was a fracture involving the entire posterior tibial margin consisting of 2 fragments: that of the posterior tubercle and that of the posteromedial margin of the tibial plafond, with the former judged to be a consequence of avulsion by the posterior inferior tibiofibular ligament and the latter a consequence of axial loading from the talus. In the remaining 5 specimens, the posterior malleolar fracture was a small extra-articular avulsion fracture. CONCLUSIONS: Fractures at the posterolateral corner of the distal tibia were shown to be avulsion fractures attributed to the posterior inferior tibiofibular ligament and produced by external rotation of the talus. A fracture involving the entire posterior tibial margin consisting of 2 fragments can be produced by a combination of avulsion by the posterior inferior tibiofibular ligament and axial loading from the talus. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association. DOI: 10.1097/OI9.0000000000000060 PMCID: PMC8022911