Does intra-articular load distribution change after lateral malleolar fractures? An in vivo study comparing operative and non-operative treatment. Issue 4 (April 2017)

• Record Type: Journal Article
• Authors: Deml, Christian; Eichinger, Martin; van Leeuwen, Wouter F.; Erhart, Stefanie; Euler, Simon A.; Brunner, Alexander
• Is Part Of: Injury. Volume 48:Issue 4(2017)
• Page Start: 854
• Page End: 860
• Publication Date: 2017-04
• Subjects: Weber b -- Ankle fracture -- Joint load -- Density distribution -- Distal fibula fracture; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2017.02.035
• Languages: English
• ISSNs: 0020-1383

Abstract

Abstract: Purpose: The impact of isolated malleolar fractures on the intra-articular load distribution within the ankle joint has been studied in several biomechanical cadaver studies during the last decades. Recently, computed tomography osteoabsorptiometry (CT-OAM) has been proposed as a valuable tool to assess intra-articular joint load distribution in vivo. The purpose of this retrospective matched pair analysis was to apply CT-OAM to evaluate in vivo changes of talar load distribution after lateral malleolar fractures in patients treated with open anatomic reduction and internal fixation (ORIF) compared to patients treated non-operatively. Methods: Ten matched pairs of patients with isolated lateral malleolar fractures with a maximum fracture dislocation of 3 mm and a median follow-up of 42 month were included into the study. Patients were matched for age, gender, and fracture dislocation. Range of ankle motion (ROM), the AOFAS hindfoot score and the Short Form 36 (SF-36) were evaluated. CT-OAM analysis of the injured and the uninjured contralateral ankles were performed. Results: Patients treated with ORIF showed a significant lower ROM compared to the uninjured contralateral ankle. No differences were found regarding clinical scores between patients treated by ORIF and those treated non-operatively. CT-OAM analysis showed symmetrical distribution of subchondral bone mineralization in comparison to the uninjured contralateral ankles for both groups of patients. Conclusions: The data of this study suggest that isolated lateral malleolar fractures with fracture gaps up to 3 mm are not associated with a change of the tibio-talar joint load distribution in vivo. Therefore, patients with isolated minimally displaced lateral malleolar fractures may achieve good clinical long-term outcome following non-operative treatment. Level of Evidence: Level III, retrospective cohort study