An analysis of data from the SFR relating to fracture classification, age, sex, cause of injury, frequency of high−/low-energy trauma and frequency of closed/open fracture was conducted. In SFR ankle fractures are classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification (Fig. The aim was also to conduct a deeper analysis of the current clinical diagnostic process regarding injury to the deltoid ligament, subsequent classification and the choice of treatment method for lateral malleolar fractures at the level of the syndesmosis.įor all patients registered at Sahlgrenska University Hospital (SU) with an ankle fracture between 1 April 2012 and 31 March 2014, data were collected from the SFR. The aim of the current study was to give an up-to-date description of the epidemiology of ankle fractures. Despite the fact that it’s been shown that medial tenderness, brusing or ecchymosis are unreliable predictors of medial ligament injury these are the signs used in clinical practice today. The best way to determine whether or not a lateral malleolar fracture at the level of the syndesmosis has an associated deltoid ligament injury has not been fully elucidated. Since the two fracture types might appear similar on plain radiographs, the physical examination of the patient is a crucial part in the decision-making regarding treatment method. On the other hand, the B2 or SER-IV fracture with a fracture pattern that proceeds to the medial side is possibly unstable and better suited to surgical treatment. The isolated lateral fracture (B1/SER-II) is by nature stable, suitable for non-surgical treatment and should not be exposed to the risk of complications due to surgery. Both a lateral malleolar fracture without an impaired deltoid ligament (SER-II or B1) and the combination of a lateral malleolar fracture with a deltoid ligament rupture (SER-IV or B2) appear as unimalleolar on plain radiographs (Fig. Lateral malleolar fractures at the level of the syndesmosis, AO/OTA 44 B fractures, are the fourth most common fracture registered in the SFR and are commonly referred to as the equivalent of Lauge-Hansen supination-external rotation (SER) injuries (Fig. studied the epidemiology of ankle fractures in Sweden between 19 but there is a lack of up to date epidemiological studies on ankle fractures. The SFR provides a unique opportunity to study the epidemiology of fractures. Several studies have been conducted in order to validate the data in the register and these studies have shown that the SFR has acceptable validity. The Swedish Fracture Register (SFR) is a national quality register that collects data on all types of fracture regarding cause of injury, type of fracture, given treatment, and subsequent treatment results. The study further suggests that there is no need to check non-surgically treated stable fractures with follow-up radiographic examination at 1 week. The results of the study also indicate a lack of consensus on how to classify and treat lateral malleolar fractures at the level of the syndesmosis. As this distinguishes if the fracture is stable or not it affects the choice of subsequent treatment. The current study demonstrates the difficulty involved in distinguishing whether or not a trans-syndesmotic lateral malleolar fracture has an associated medial ligament injury or not. For the non-surgically treated patients with medial tenderness, the treatment plan was changed to surgical treatment after the 1-week radiographic follow-up in 1 patient (1%) and 1 patient (1%) was treated surgically after 3 months due to non-union. Among the surgically treated patients 18% ( n = 24) were found to have no medial tenderness. According to the preoperative physical examination described in the medical records, medial tenderness was found in 73 (24%) of the non-surgically treated patients. 439 of the patients with B1 fractures were included in the detailed study and of these 309 (70%) were treated non-surgically and 130 patients (30%) surgically. 838 (63%) were B-fractures and 512 (38%) of these were B1 fractures. For identified AO/OTA44-B1 fractures, medical records and radiographs were reviewed and analyzed. Observational data regarding all ankle fractures treated at SU between 1 April 2012 and 31 March 2014 was collected from the Swedish Fracture Register. The aim of this study was to describe the epidemiology of ankle fractures treated at Sahlgrenska University Hospital (SU) during a 2-year period and analyze the current diagnostic process, classification and choice of treatment for lateral malleolar fractures at the level of the syndesmosis. The decision regarding which trans syndesmotic ankle fractures to treat surgically and which to treat non-surgically is a matter of debate.
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