Quantitative T2 Mapping Analysis With MRI of Talar Cartilage in Ankle Trauma: A Study Based on Lauge-Hansen Classification and Anatomical Locations.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors have no potential conflicts of interest to disclose. 16. J Foot Ankle Surg. 2020 Nov-Dec;59(6):1275-1278. doi: 10.1053/j.jfas.2019.10.014. Epub 2020 Aug 21. Ankle Fracture with a Complex Injury Mechanism and Misleading Hook Test Result: A Case Report. Guo H(1), Huang W(2), Zeng C(3). Author information: (1)Resident, Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China; Member, Chinese Orthopedic Foot and Ankle Society, Beijing, P.R. China. (2)Attending, Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China. (3)Director, Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China; Vice Chairman, Youth Committee of Chinese Orthopedic Foot and Ankle Society, Beijing, P.R. China; International Member, American Orthopaedic Foot & Ankle Society, Rosemont, IL. Electronic address: zengcanjun@163.com. Ankle fractures and their mechanisms of injury can be complex. We report a case of a patient with an uncertain mechanism of injury and an uncommon combination of lower extremity fractures, which fit the criteria for a Lauge-Hansen classification pronation-external-rotation fracture, Maisonneuve fracture, Wagstaffe fracture, and posterior pilon fracture. Plain radiographs and computed tomography scan revealed Chaput tubercle avulsion fractures, an anterior distal fibular fracture fragment, multiple lateral malleolar fractures, a posterior malleolar fracture fragment with proximal displacement, a die-punch fragment between the posterior malleolar fragment and the tibia, a proximal fibular fracture, and possible ankle syndesmotic diastasis. Intraoperative hook test was negative after fixation of the fractures, so syndesmotic fixation was not performed. At 3-month follow-up, plain radiographs showed obvious syndesmotic diastasis. At 1-year follow-up, symptoms persisted and syndesmotic fusion was recommended but declined by the patient. This case demonstrates that both ankle fractures and their mechanisms of injury can be remarkably complex and confusing, posterior pilon fractures can occur along with pronation-external-rotation ankle fractures, syndesmotic fixation should be considered for all patients with Maisonneuve fractures, reliance on the hook test for surgical management decisions may not always be reliable, and there exists a need for a more accurate and reliable intraoperative test to determine the presence of ankle syndesmotic injury. Copyright © 2020 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved. DOI: 10.1053/j.jfas.2019.10.014