Managing type II and type IV Lauge-Hansen supination external rotation ankle fractures: current orthopaedic practice

Abstract

INTRODUCTION Differentiating supination external rotation (SER) type II and IV ankle injuries is challenging in the absence of a medial malleolar fracture or talar shift on radiographs. The accurate differentiation between a stable SER-II from an unstable SER-IV injury would allow implementation of the appropriate management plan from diagnosis. The aim of this study was to ascertain the practice of orthopaedic surgeons in dealing with these injuries. MATERIALS AND METHODS A postal survey was undertaken on 216 orthopaedic consultants from three regions. RESULTS In the presence of medial-sided clinical signs (tenderness, swelling, ecchymosis), 22% of consultants would perform surgical fixation. 53% would choose non-operative treatment and the majority would monitor these fractures through serial radiographs. The remaining 25% of consultants would perform an examination under anaesthesia (EUA; 15%), request stress radiographs (9%) or an MRI scan (1%). Without medial-sided signs, 85% would advocate non-operative treatment and, of these, 74% would perform weekly radiographs. Interestingly, 6% would perform immediate surgical fixation. Stress radiographs (6%) and EUAs (2%) were advocated in the remaining group of consultants. Foot and ankle surgeons utilised stress radiographs more frequently and were more likely to proceed to surgical fixation should talar shift be demonstrated. CONCLUSIONS Clinical practice is varied amongst the orthopaedic community. This may lead to unnecessary surgery in SER-II injuries and delay in diagnosis and operative management of SER-IV injuries. We have highlighted the various investigative modalities available that may be used in conjunction with clinical signs to make a more accurate diagnosis. KOSUGE MAHADEVAN CHANDRASENAN PUGH MANAGING TYPE II AND TYPE IV LAUGE-HANSEN SUPINATION EXTERNAL ROTATION ANKLE FRACTURESAnn R Coll Surg Engl 2010; 92: 689-692 690 Materials and MethodsA postal survey was sent to 216 consultant orthopaedic surgeons in three regions -London Pan-Thames, East Midlands (South) and East Midlands (North). Consultants were identified through various searches from regional records and website resources. The questionnaire was designed to identify treatment pathways of SER-II and SER-IV injuries. Two scenarios were presented in keeping with the injury patterns being investigated. In addition, information regarding whether correspondents had a subspecialty interest in foot and ankle surgery was obtained. The data were analysed using statistical software (SPSS v16.0 for Windows; SPSS Inc., IL, USA). ResultsA total of 118 questionnaires were returned (55% response rate). Eighteen of the replies were from consultants who were no longer involved in trauma work and declined participation. Of the 100 questionnaires analysed, 18% of respondents were consultants who had specialist interests in foot and ankle surgery.In definite SER-II injuries, the preferred treatment was non-operative in a cast/splint (85%).The remaining 15% would perform open reduction and internal fixa...

Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial

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“…42 Further, there is a significant degree of variation in practice among orthopedic surgeons for operative management of ankle fractures. 43,44 In a recent survey, only 82% routinely chose surgery for grossly unstable type IV supination external rotation ankle fractures. 44…”

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