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Trauma
Published in Harry Griffiths, Musculoskeletal Radiology, 2008
Stage 1 is a transverse fracture of the medial malleolus or a tear of the deltoid ligament. Stage 2 is with the addition of a tear of the inferior anterior tibiofibular and intraosseous ligaments. Stage 3 is with the addition of a tear of the intraosseous membrane to the level of the spiral fracture of the fibula, 7 or 8 cm up the fibula, or a more proximal fracture at the tip of the lateral malleolus. Stage 4 is all of the above with the addition of an avulsion fracture off the posterior lip of the tibia at the attachment to the posterior inferior and inferior transverse tibiofibular ligament. This is a true trimalleolar fracture. Thus, pronation external rotation injuries are classically with a transverse fracture of the medial malleolus at the level of the ankle mortise and a high fracture of the fibula and a tear of the syndesmosis. There are eight subtypes of this injury.
Randomized trial comparing suture button with single 3.5 mm syndesmotic screw for ankle syndesmosis injury: similar results at 2 years
Published in Acta Orthopaedica, 2020
Benedikte Wendt Ræder, Ingrid Kvello Stake, Jan Erik Madsen, Frede Frihagen, Silje Berild Jacobsen, Mette Renate Andersen, Wender Figved
At 2 years, 30 patients in the SB group and 27 patients in the TS group had radiological signs of ankle OA (RR 1.1, CI 0.7–1.7). When analyzing for advanced OA, there was a difference between the groups at 2 years: 8 patients in the SB group and 1 patient in the TS group had advanced OA (RR 8, CI 1–60). The groups displayed similar results when analyzing presence of talar osteophytes at 2 years: 12 in the SB group and 7 in the TS group (p = 0.3). At 2 years, 0 patients in the SB group and 5 patients in the TS group had complete synostosis (p = 0.03) (Figure 4, see Supplementary data). When stratifying the complete cohort at 2 years according to fracture pattern, patients with a Maisonneuve fracture had less OA (15 vs. 42, RR 0.7, CI 0.4–1.0), patients with a trimalleolar fracture had more OA (19 vs. 38, RR 1.6, CI 1.2–2.1).