Supination adduction ankle fractures: Ankle fracture or pilon variant?
Adult
Ankle Fractures
/ diagnostic imaging
Ankle Joint
/ physiopathology
Equipment Failure
External Fixators
Female
Fracture Fixation, Internal
/ methods
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Radiography
Range of Motion, Articular
Retrospective Studies
Supination
Tibial Fractures
/ diagnostic imaging
Treatment Outcome
Journal
Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
07
10
2019
revised:
26
11
2019
accepted:
05
01
2020
pubmed:
15
1
2020
medline:
23
1
2021
entrez:
15
1
2020
Statut:
ppublish
Résumé
Supination adduction (SAD) fractures are rotational ankle fractures with a characteristic vertical medial malleolus fracture and tension failure fibula fracture. While these fractures are considered rotational injuries, they can have joint impaction that could lead to early joint degeneration. The purpose of this study was to characterize SAD ankle fractures and compare these injuries with partial articular pilon fractures. Following IRB approval, we retrospectively reviewed ankle and pilon fractures (OTA 43 & 44) treated at two academic level-1 trauma centers from 2008-2016. Our primary outcome was failure defined as either ankle arthrodesis or arthroplasty. Infection and significant arthrosis were also compared. We performed multivariate Cox regression to compare failure between SAD ankles and pilon fractures. Seventy-nine SAD ankle and 91 pilon fractures met inclusion criteria. Patient demographics including age and open injury did not differ between groups. For SAD ankle fractures, impaction occurred in 66% (44/79) of injuries. Impaction failed to be significant risk factor for arthrosis after adjustment for malreduction (p = 0.13). Failure was significantly more common in pilon fractures (11/91, 12%) than SAD fractures (5/79, 6%) (HR=0.25, 95% CI:[0.07,0.92], p = 0.036). Infection and arthrosis rates failed to show a difference between the groups (p = 0.19, 0.63, respectively). Malreduction was significantly associated with joint arthrosis (OR=7.05, 95% CI: [1.63,36.12], p = 0.01). Rotational ankle fractures have low rates (<2%) of ankle arthrodesis or arthroplasty. The present study demonstrates that SAD ankles have failure (6%) that remains somewhere between rotational ankle fractures and pilon fractures (12%) on the ankle injury spectrum. Level 3, Prognostic.
Sections du résumé
BACKGROUND
BACKGROUND
Supination adduction (SAD) fractures are rotational ankle fractures with a characteristic vertical medial malleolus fracture and tension failure fibula fracture. While these fractures are considered rotational injuries, they can have joint impaction that could lead to early joint degeneration. The purpose of this study was to characterize SAD ankle fractures and compare these injuries with partial articular pilon fractures.
METHODS
METHODS
Following IRB approval, we retrospectively reviewed ankle and pilon fractures (OTA 43 & 44) treated at two academic level-1 trauma centers from 2008-2016. Our primary outcome was failure defined as either ankle arthrodesis or arthroplasty. Infection and significant arthrosis were also compared. We performed multivariate Cox regression to compare failure between SAD ankles and pilon fractures.
RESULTS
RESULTS
Seventy-nine SAD ankle and 91 pilon fractures met inclusion criteria. Patient demographics including age and open injury did not differ between groups. For SAD ankle fractures, impaction occurred in 66% (44/79) of injuries. Impaction failed to be significant risk factor for arthrosis after adjustment for malreduction (p = 0.13). Failure was significantly more common in pilon fractures (11/91, 12%) than SAD fractures (5/79, 6%) (HR=0.25, 95% CI:[0.07,0.92], p = 0.036). Infection and arthrosis rates failed to show a difference between the groups (p = 0.19, 0.63, respectively). Malreduction was significantly associated with joint arthrosis (OR=7.05, 95% CI: [1.63,36.12], p = 0.01).
CONCLUSION
CONCLUSIONS
Rotational ankle fractures have low rates (<2%) of ankle arthrodesis or arthroplasty. The present study demonstrates that SAD ankles have failure (6%) that remains somewhere between rotational ankle fractures and pilon fractures (12%) on the ankle injury spectrum.
LEVEL OF EVIDENCE
METHODS
Level 3, Prognostic.
Identifiants
pubmed: 31932039
pii: S0020-1383(20)30009-7
doi: 10.1016/j.injury.2020.01.008
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
759-763Informations de copyright
Copyright © 2020. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors have the following conflicts to report: Dr. Haller is a paid lecturer for AO North America, serves as a consultant for NewClip Technics, serves as a committee member of the OTA, and receives grant funding from the OTA, DOD, and LS Peery Foundation. Dr. Githens is a paid lecturer for AO North America. Dr. Rothberg is a paid lecturer for AO North America.