SLR - February 2011 - Benjamin Cullen
Reference: van den Bekerom, M.P., van Dijk, C.N. (2010). Is fibular fracture displacement consistent with tibiotalar displacement? Clinical Orthopedics and Related Research, 468(4), 969-74
Scientific Literature Review
Reviewed by: Benjamin Cullen, DPM, PGY-1
Residency Program: Kaiser Hayward
Podiatric Relevance:
Ankle fractures are common injuries treated by podiatric surgeons, with SER Stage II the most frequently diagnosed mechanism. Historically, 2 mm or greater displacement of the fibular fracture has been used as the indication for surgical management in order to prevent incongruency of the mortise. The authors investigated whether this guideline is supported by pre- and postoperative radiographic analysis of tibiotalar alignment.
Methods:
55 adult patients with SER Stage II ankle fractures were retrospectively reviewed. The average interval between trauma and operation was 4.2 days (range, 0–12 days). The average age was
42 years (range, 17–89 years). Each patient had greater than 2 mm of displacement of the fibular fracture, and no associated deltoid ligament injury based on benign clinical exam and normal medial clear space. No signs of syndesmotic instability were found using intraoperative hook testing. Fibular fractures were fixed using standard AO technique.
Three measurements were made on the mortise view and compared pre- and postoperatively: distance from tibia to proximal fibular fragment, distance from tibia to distal fibular fragment, and distance from the proximal fibular fracture fragment to the distal fibular fracture fragment.
Results:
The average interfragmentary displacement was 2.3 mm preoperatively and 0.1 mm post-operatively. There was an average 1.8 mm medial displacement of the proximal fibular fragment, and an average of 0.6 mm lateral displacement of the distal fibular fragment when comparing pre- and postoperative measurements.
Conclusions:
The authors report that the amount of fibular interfragmentary displacement did not correlate with lateral displacement of the distal fibular fragment (2.3 mm vs 0.6 mm). As such, they argue that tibiotalar incongruency does not occur in SER Stage II fractures without syndesmotic instability, and so surgical management is not indicated based solely on interfragmentary fibular displacement greater than 2 mm.