A systematic review of ankle fracture-dislocations: Recent update and future prospects.

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Abstract

Conflict of interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. 15. Foot Ankle Int. 2013 Nov;34(11):1516-20. doi: 10.1177/1071100713491730. Epub 2013 May 31. Correlation of AO and Lauge-Hansen classification systems for ankle fractures to the mechanism of injury. Rodriguez EK(1), Kwon JY, Herder LM, Appleton PT. Author information: (1)Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA. Comment in Foot Ankle Int. 2013 Dec;34(12):1750. doi: 10.1177/1071100713502467. Foot Ankle Int. 2013 Dec;34(12):1751. doi: 10.1177/1071100713507039. Foot Ankle Int. 2014 Apr;35(4):423. doi: 10.1177/1071100714522232. Foot Ankle Int. 2014 Apr;35(4):424. doi: 10.1177/1071100714522399. BACKGROUND: Our aim was to assess whether the Lauge-Hansen (LH) and the Muller AO classification systems for ankle fractures radiographically correlate with in vivo injuries based on observed mechanism of injury. METHODS: Videos of potential study candidates were reviewed on YouTube.com. Individuals were recruited for participation if the video could be classified by injury mechanism with a high likelihood of sustaining an ankle fracture. Corresponding injury radiographs were obtained. Injury mechanism was classified using the LH system as supination/external rotation (SER), supination/adduction (SAD), pronation/external rotation (PER), or pronation/abduction (PAB). Corresponding radiographs were classified by the LH system and the AO system. RESULTS: Thirty injury videos with their corresponding radiographs were collected. Of the video clips reviewed, 16 had SAD mechanisms and 14 had PER mechanisms. There were 26 ankle fractures, 3 nonfractures, and 1 subtalar dislocation. Twelve fractures with SAD mechanisms had corresponding SAD fracture patterns. Five PER mechanisms had PER fracture patterns. Eight PER mechanisms had SER fracture patterns and 1 had SAD fracture pattern. When the AO classification was used, all 12 SAD type injuries had a 44A type fracture, whereas the 14 PER injuries resulted in nine 44B fractures, two 44C fractures, and three 43A fractures. CONCLUSION: When injury video clips of ankle fractures were matched to their corresponding radiographs, the LH system was 65% (17/26) consistent in predicting fracture patterns from the deforming injury mechanism. When the AO classification system was used, consistency was 81% (21/26). The AO classification, despite its development as a purely radiographic system, correlated with in vivo injuries, as based on observed mechanism of injury, more closely than did the LH system. LEVEL OF EVIDENCE: Level IV, case series. DOI: 10.1177/1071100713491730