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The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review

The supination–external rotation or Weber B type fracture exists as a stable and an unstable type. The unstable type has a medial malleolus fracture or deltoid ligament lesion in addition to a fibular fracture. The consensus is the unstable type and best treated by open reduction and internal fixati...

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Autores principales: Stufkens, Sjoerd A. S., van den Bekerom, Michel P. J., Knupp, Markus, Hintermann, Beat, van Dijk, C. Niek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Milan 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535131/
https://www.ncbi.nlm.nih.gov/pubmed/22767333
http://dx.doi.org/10.1007/s11751-012-0140-9
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author Stufkens, Sjoerd A. S.
van den Bekerom, Michel P. J.
Knupp, Markus
Hintermann, Beat
van Dijk, C. Niek
author_facet Stufkens, Sjoerd A. S.
van den Bekerom, Michel P. J.
Knupp, Markus
Hintermann, Beat
van Dijk, C. Niek
author_sort Stufkens, Sjoerd A. S.
collection PubMed
description The supination–external rotation or Weber B type fracture exists as a stable and an unstable type. The unstable type has a medial malleolus fracture or deltoid ligament lesion in addition to a fibular fracture. The consensus is the unstable type and best treated by open reduction and internal fixation. The diagnostic process for a medial ligament lesion has been well investigated but there is no consensus as to the best method of assessment. The number of deltoid ruptures as a result of an external rotation mechanism is higher than previously believed. The derivation of the injury mechanism could provide information of the likely ligamentous lesion in several fracture patterns. The use of the Lauge-Hansen classification system in the assessment of the initial X-ray images can be helpful in predicting the involvement of the deltoid ligament but the reliability in terms of sensitivity and specificity is unknown. Clinical examination, stress radiography, magnetic resonance imaging, arthroscopy, and ultrasonography have been used to investigate medial collateral integrity in cases of ankle fractures. None of these has shown to possess the combination of being cost-effective, reliable and easy to use; currently gravity stress radiography is favoured and, in cases of doubt, arthroscopy could be of value. There is a disagreement as to the benefit of repair by suture of the deltoid ligament in cases of an acute rupture in combination with a lateral malleolar fracture. There is no evidence found for suturing but exploration is thought to be beneficial in case of interposition of medial structures.
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spelling pubmed-35351312013-01-04 The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review Stufkens, Sjoerd A. S. van den Bekerom, Michel P. J. Knupp, Markus Hintermann, Beat van Dijk, C. Niek Strategies Trauma Limb Reconstr Review The supination–external rotation or Weber B type fracture exists as a stable and an unstable type. The unstable type has a medial malleolus fracture or deltoid ligament lesion in addition to a fibular fracture. The consensus is the unstable type and best treated by open reduction and internal fixation. The diagnostic process for a medial ligament lesion has been well investigated but there is no consensus as to the best method of assessment. The number of deltoid ruptures as a result of an external rotation mechanism is higher than previously believed. The derivation of the injury mechanism could provide information of the likely ligamentous lesion in several fracture patterns. The use of the Lauge-Hansen classification system in the assessment of the initial X-ray images can be helpful in predicting the involvement of the deltoid ligament but the reliability in terms of sensitivity and specificity is unknown. Clinical examination, stress radiography, magnetic resonance imaging, arthroscopy, and ultrasonography have been used to investigate medial collateral integrity in cases of ankle fractures. None of these has shown to possess the combination of being cost-effective, reliable and easy to use; currently gravity stress radiography is favoured and, in cases of doubt, arthroscopy could be of value. There is a disagreement as to the benefit of repair by suture of the deltoid ligament in cases of an acute rupture in combination with a lateral malleolar fracture. There is no evidence found for suturing but exploration is thought to be beneficial in case of interposition of medial structures. Springer Milan 2012-07-06 2012-08 /pmc/articles/PMC3535131/ /pubmed/22767333 http://dx.doi.org/10.1007/s11751-012-0140-9 Text en © The Author(s) 2012 https://creativecommons.org/licenses/by/4.0/ This article is published under license to BioMed Central Ltd. Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Review
Stufkens, Sjoerd A. S.
van den Bekerom, Michel P. J.
Knupp, Markus
Hintermann, Beat
van Dijk, C. Niek
The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review
title The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review
title_full The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review
title_fullStr The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review
title_full_unstemmed The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review
title_short The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review
title_sort diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535131/
https://www.ncbi.nlm.nih.gov/pubmed/22767333
http://dx.doi.org/10.1007/s11751-012-0140-9
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