Stability-based classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury

Acta Orthopaedica

Volumn 83, Issue SUPPL.347, 2012, Pages 1-31

  Pakarinen, Harri ^a  

^a OULU UNIVERSITY HOSPITAL   (Finland)

Author keywords

[No Author keywords available]

Indexed keywords

ANKLE; ANKLE FRACTURE; ARTICLE; BODY POSTURE; CLINICAL ASSESSMENT TOOL; CLINICAL DECISION MAKING; COMPUTER ASSISTED TOMOGRAPHY; DISEASE CLASSIFICATION; FOLLOW UP; HUMAN; NAMED INVENTORIES, QUESTIONNAIRES AND RATING SCALES; OLERUD MOLANDER SCORING SYSTEM; OUTCOME ASSESSMENT; PROSPECTIVE STUDY; RADIOGRAPHY; RAND 36 ITEM HEALTH SRUVEY; SCORING SYSTEM; SENSITIVITY AND SPECIFICITY; STRESS; WEBER CLASSIFICATION SYSTEM; WEIGHT BEARING;

ADOLESCENT; ADULT; AGED; AGED, 80 AND OVER; ANKLE INJURIES; BIOMECHANICS; DIAGNOSTIC TESTS, ROUTINE; FEMALE; FRACTURE FIXATION; FRACTURES, BONE; HUMANS; JOINT INSTABILITY; MALE; MIDDLE AGED; OBSERVER VARIATION; PROSPECTIVE STUDIES; RETROSPECTIVE STUDIES; ROTATION; SENSITIVITY AND SPECIFICITY; STRESS, MECHANICAL; SUPINATION; TREATMENT OUTCOME; YOUNG ADULT;

EID: 84870748073     PISSN: 17453674     EISSN: 17453682     Source Type: Journal    
DOI: 10.3109/17453674.2012.745657     Document Type: Article

References (174)

1. Aalto A-M, Aro A, Teperi J. RAND 36 terveyteen liittyvän elämänlaadun mittarina RAND 36 as a measure of quality of life . Gummerus Kirjapaino Oy, Saarijärvi 1999.
2. Ahl T, Dalen N, Lundberg A, Bylund C. Early mobilization of operated on ankle fractures. Prospective, controlled study of 40 bimalleolar cases. Acta Orthop Scand 1993; 64(1): 95-99. (Pubitemid 23092316)
3. Ahl T, Dalen N, Selvik G. Mobilization after operation of ankle fractures. Good results of early motion and weight bearing. Acta Orthop Scand 1988; 59(3): 302-306.
4. Ahl T, Dalen N, Selvik G. Ankle fractures. A clinical and roentgenographic stereophotogrammetric study. Clin Orthop Relat Res 1989;(245): 246-255.
5. Ali M S, McLaren C A, Rouholamin E, O'Connor B T. Ankle fractures in the elderly: nonoperative or operative treatment. J Orthop Trauma 1987; 1(4): 275-280.
6. Amendola A. Controversies in diagnosis and management of syndesmosis injuries of the ankle. Foot Ankle 1992; 13(1): 44-50.
7. Babis G C, Papagelopoulos P J, Tsarouchas J, Zoubos A B, Korres D S, Nikiforidis P. Operative treatment for Maisonneuve fracture of the proximal fibula. Orthopedics 2000; 23(7): 687-690. (Pubitemid 30463892)
8. Bachmann L M, Kolb E, Koller M T, Steurer J, ter R G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 2003; 326(7386): 417-419. (Pubitemid 36246310)
9. Bauer M, Bengner U, Johnell O, Redlund-Johnell I. Supination-eversion fractures of the ankle joint: changes in incidence over 30 years. Foot Ankle 1987a; 8(1): 26-28.
10. Bauer M, Bergstrom B, Hemborg A, Sandegard J. Malleolar fractures: nonoperative versus operative treatment. A controlled study. Clin Orthop Relat Res 1985a;(199): 17-27. (Pubitemid 16225175)
11. Bauer M, Johnell O, Redlund-Johnell I, Johnsson K. Ankle fractures. Foot Ankle 1987b; 8(1): 23-25.
12. Bauer M, Jonsson K, Nilsson B. Thirty-year follow-up of ankle fractures. Acta Orthop Scand 1985b; 56(2): 103-106. (Pubitemid 15011344)
13. Bava E, Charlton T, Thordarson D. Ankle fracture syndesmosis fixation and management: the current practice of orthopedic surgeons. Am J Orthop (Belle Mead NJ) 2010; 39(5): 242-246.
14. Beauchamp C G, Clay N R, Thexton P W. Displaced ankle fractures in patients over 50 years of age. J Bone Joint Surg Br 1983; 65(3): 329-332. (Pubitemid 13134299)
15. Bengner U, Johnell O, Redlund-Johnell I. Epidemiology of ankle fracture 1950 and 1980. Increasing incidence in elderly women. Acta Orthop Scand 1986; 57(1): 35-37. (Pubitemid 16168159)
16. Beumer A. Chronic instability of the anterior syndesmosis of the ankle. Acta Orthop Suppl 2007; 78(327): 4-36.
17. Beumer A, Campo M M, Niesing R, Day J, Kleinrensink G J, Swierstra B A. Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation. Injury 2005; 36(1): 60-64. (Pubitemid 39611303)
18. Beumer A, Valstar E R, Garling E H, van Leeuwen W J, Sikma W, Niesing R, Ranstam J, Swierstra B A. External rotation stress imaging in syndesmotic injuries of the ankle: comparison of lateral radiography and radiostereometry in a cadaveric model. Acta Orthop Scand 2003; 74(2): 201-205. (Pubitemid 36628218)
19. Beumer A, van Hemert W L, Niesing R, Entius C A, Ginai A Z, Mulder P G, Swierstra B A. Radiographic measurement of the distal tibiofibular syndesmosis has limited use. Clin Orthop Relat Res 2004;(423): 227-234. (Pubitemid 38787743)
20. Boden S D, Labropoulos P A, McCowin P, Lestini W F, Hurwitz S R. Mechanical considerations for the syndesmosis screw. A cadaver study. J Bone Joint Surg Am 1989; 71(10): 1548-1555. (Pubitemid 20054472)
21. Boytim M J, Fischer D A, Neumann L. Syndesmotic ankle sprains. Am J Sports Med 1991; 19(3): 294-298.
22. Brage M E, Rockett M, Vraney R, Anderson R, Toledano A. Ankle fracture classification: a comparison of reliability of three X-ray views versus two. Foot Ankle Int 1998; 19(8): 555-562. (Pubitemid 28405140)
23. Brand D A, Frazier W H, Kohlhepp W C, Shea K M, Hoefer A M, Ecker M D, Kornguth P J, Pais M J, Light T R. A protocol for selecting patients with injured extremities who need x-rays. N Engl J Med 1982; 306(6): 333-339. (Pubitemid 12169114)
24. Brandser E A, Berbaum K S, Dorfman D D, Braksiek R J, el-Khoury G Y, Saltzman C L, Marsh J L, Clark W A. Contribution of individual projections alone and in combination for radiographic detection of ankle fractures. Am J Roentgenol 2000; 174(6): 1691-1697. (Pubitemid 30346741)
25. Brooks S C, Potter B T, Rainey J B. Inversion injuries of the ankle: clinical assessment and radiographic review. BMJ (Clin Res Ed) 1981; 282(6264): 607-608. (Pubitemid 11146285)
26. Broos P L, Bisschop A P. Operative treatment of ankle fractures in adults: correlation between types of fracture and final results. Injury 1991; 22(5): 403-406.
27. Brown O L, Dirschl D R, Obremskey W T. Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma 2001; 15(4): 271-274. (Pubitemid 32611314)
28. Brown T D, Hurlbut P T, Hale J E, Gibbons T A, Caldwell N J, Marsh J L, Nepola J V. Effects of imposed hindfoot constraint on ankle contact mechanics for displaced lateral malleolar fractures. J Orthop Trauma 1994; 8(6): 511-519.
29. Buckwalter J A, Einhorn T A, Marsh J L. In: Rockwood and Green's Fractures in Adults. (Eds. Bucholz RW, Heckman JD). Lippincott Williams & Wilkins, Philadelphia, 2001; 245-271.
30. Buhr A J, Cooke A M. Fracture patterns. Lancet 1959; 1(7072): 531-536.
31. Burwell H N, Charnley A D. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg Br 1965; 47(4): 634-660.
32. Calhoun J H, Li F, Ledbetter B R, Viegas S F. A comprehensive study of pressure distribution in the ankle joint with inversion and eversion. Foot Ankle Int 1994; 15(3): 125-133. (Pubitemid 24102397)
33. Candal-Couto J J, Burrow D, Bromage S, Briggs P J. Instability of the tibiofibular syndesmosis: have we been pulling in the wrong direction? Injury 2004; 35(8): 814-818. (Pubitemid 38891660)
34. Cedell C A. Outward rotation-supination injuries of the ankle. Clin Orthop Relat Res 1965; 42: 97-100.
35. Cedell C A. Supination-outward rotation injuries of the ankle. A clinical and roentgenological study with special reference to the operative treatment. Acta Orthop Scand 1967; Suppl.
36. Cheung Y, Perrich K D, Gui J, Koval K J, Goodwin D W. MRI of isolated distal fibular fractures with widened medial clear space on stressed radiographs: which ligaments are interrupted? AJR Am J Roentgenol 2009; 192(1): W7-12.
37. Chissell H R, Jones J. The influence of a diastasis screw on the outcome of Weber type-C ankle fractures. J Bone Joint Surg Br 1995; 77(3): 435-438.
38. Cimino W, Ichtertz D, Slabaugh P. Early mobilization of ankle fractures after open reduction and internal fixation. Clin Orthop Relat Res 1991;(267): 152-156.
39. Clarke H J, Michelson J D, Cox Q G, Jinnah R H. Tibio-talar stability in bimalleolar ankle fractures: a dynamic in vitro contact area study. Foot Ankle 1991; 11(4): 222-227.
40. Close J R. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg Am 1956; 38-A(4): 761-781.
41. Cockshott W P, Jenkin J K, Pui M. Limiting the use of routine radiography for acute ankle injuries. Can Med Assoc J 1983; 129(2): 129-131. (Pubitemid 13039991)
42. Cottom J M, Hyer C F, Philbin T M, Berlet G C. Transosseous fixation of the distal tibiofibular syndesmosis: comparison of an interosseous suture and endobutton to traditional screw fixation in 50 cases. J Foot Ankle Surg 2009; 48(6): 620-630.
43. Cotton FJ. The ankle. In: Dislocations and Joint-Fractures. WB Saunders, Philadelphia, 1910; 535-589.
44. Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures - an increasing problem? Acta Orthop Scand 1998; 69(1): 43-47. (Pubitemid 28105160)
45. Craig W L, III, Dirschl D R. Effects of binary decision making on the classification of fractures of the ankle. J Orthop Trauma 1998; 12(4): 280-283.
46. Daly P J, Fitzgerald R H, Jr., Melton L J, Ilstrup D M. Epidemiology of ankle fractures in Rochester, Minnesota. Acta Orthop Scand 1987; 58(5): 539-544. (Pubitemid 18034249)
47. Dunlop M G, Beattie T F, White G K, Raab G M, Doull R I. Guidelines for selective radiological assessment of inversion ankle injuries. BMJ (Clin Res Ed) 1986; 293(6547): 603-605. (Pubitemid 16026159)
48. Earll M, Wayne J, Brodrick C, Vokshoor A, Adelaar R. Contribution of the deltoid ligament to ankle joint contact characteristics: a cadaver study. Foot Ankle Int 1996; 17(6): 317-324. (Pubitemid 26192832)
49. Ebraheim N A, Mekhail A O, Gargasz S S. Ankle fractures involving the fibula proximal to the distal tibiofibular syndesmosis. Foot Ankle Int 1997; 18(8): 513-521. (Pubitemid 27355827)
50. Edwards G S, Jr., DeLee J C. Ankle diastasis without fracture. Foot Ankle 1984; 4(6): 305-312. (Pubitemid 14091661)
51. Egol K A, Amirtharajah M, Tejwani N C, Capla E L, Koval K J. Ankle stress test for predicting the need for surgical fixation of isolated fibular fractures. J Bone Joint Surg Am 2004; 86-A(11): 2393-2398. (Pubitemid 39473077)
52. Elgafy H, Semaan H B, Blessinger B, Wassef A, Ebraheim N A. Computed tomography of normal distal tibiofibular syndesmosis. Skeletal Radiol 2010; 39(6): 559-564.
53. Eventov I, Salama R, Goodwin D R, Weissman S L. An evaluation of surgical and conservative treatment of fractures of the ankle in 200 patients. J Trauma 1978; 18(4): 271-274. (Pubitemid 8358110)
54. Finsen V, Saetermo R, Kibsgaard L, Farran K, Engebretsen L, Bolz K D, Benum P. Early postoperative weight-bearing and muscle activity in patients who have a fracture of the ankle. J Bone Joint Surg Am 1989; 71(1): 23-27. (Pubitemid 19070387)
55. Fleiss JL. Statistical methods for rates and proportions. 2nd ed. New York: John Wiley & Sons; 1981:217-8.
56. Gardner M J, Brodsky A, Briggs S M, Nielson J H, Lorich D G. Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res 2006a; 447: 165-171. (Pubitemid 44324911)
57. Gardner M J, Demetrakopoulos D, Briggs S M, Helfet D L, Lorich D G. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int 2006b; 27(10): 788-792. (Pubitemid 44497845)
58. Gardner M J, Demetrakopoulos D, Briggs S M, Helfet D L, Lorich D G. The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures: an MRI study. J Orthop Trauma 2006c; 20(4): 267-272. (Pubitemid 44309641)
59. Georgiadis G M, White D B. Modified tension band wiring of medial malleolar ankle fractures. Foot Ankle Int 1995; 16(2): 64-68.
60. Gill J B, Risko T, Raducan V, Grimes J S, Schutt R C, Jr. Comparison of manual and gravity stress radiographs for the evaluation of supinationexternal rotation fibular fractures. J Bone Joint Surg Am 2007; 89(5): 994-999. (Pubitemid 46724589)
61. Goergen T G, Danzig L A, Resnick D, Owen C A. Roentgenographic evaluation of the tibiotalar joint. J Bone Joint Surg Am 1977; 59(7): 874-877. (Pubitemid 8218243)
62. Greenfield D M, Eastell R. Risk factors for ankle fracture. Osteoporos Int 2001; 12(2): 97-103. (Pubitemid 32244661)
63. Hahn D M, Colton C L. Malleoli. In: AO Principles of Fracture Management. Vol. 2. (Eds. Rüedi T P, Buckley R E, Moran C G). AO Publishing, Davos, 2007; 871-897.
64. Haraguchi N, Armiger R S. A new interpretation of the mechanism of ankle fracture. J Bone Joint Surg Am 2009; 91(4): 821-829.
65. Harper M C. An anatomic study of the short oblique fracture of the distal fibula and ankle stability. Foot Ankle 1983; 4(1): 23-29.
66. Harper M C. The short oblique fracture of the distal fibula without medial injury: an assessment of displacement. Foot Ankle Int 1995; 16(4): 181-186.
67. Harper M C, Keller T S. A radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle 1989; 10(3): 156-160. (Pubitemid 20072328)
68. Hays R D, Morales L S. The RAND-36 measure of health-related quality of life. Ann Med 2001; 33(5): 350-357. (Pubitemid 32675376)
69. Hedstrom M, Ahl T, Dalen N. Early postoperative ankle exercise. A study of postoperative lateral malleolar fractures. Clin Orthop Relat Res 1994;(300): 193-196. (Pubitemid 24085496)
70. Hopkinson W J, St P P, Ryan J B, Wheeler J H. Syndesmosis sprains of the ankle. Foot Ankle 1990; 10(6): 325-330. (Pubitemid 20315332)
71. Hovis W D, Kaiser B W, Watson J T, Bucholz R W. Treatment of syndesmotic disruptions of the ankle with bioabsorbable screw fixation. J Bone Joint Surg Am 2002; 84-A(1): 26-31.
72. Hughes J. The medial malleolus in ankle fractures. Orthop Clin North Am 1980; 11(3): 649-660. (Pubitemid 10012458)
73. Hughes J L, Weber H, Willenegger H, Kuner E H. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Relat Res 1979;(138): 111-119. (Pubitemid 9199091)
74. Jaskulka R A, Ittner G, Schedl R. Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. J Trauma 1989; 29(11): 1565-1570. (Pubitemid 20013518)
75. Jenkinson R J, Sanders D W, MacLeod M D, Domonkos A, Lydestadt J. Intraoperative diagnosis of syndesmosis injuries in external rotation ankle fractures. J Orthop Trauma 2005; 19(9): 604-609. (Pubitemid 41598075)
76. Jensen S L, Andresen B K, Mencke S, Nielsen P T. Epidemiology of ankle fractures. A prospective population-based study of 212 cases in Aalborg, Denmark. Acta Orthop Scand 1998; 69(1): 48-50. (Pubitemid 28105161)
77. Joy G, Patzakis M J, Harvey J P, Jr. Precise evaluation of the reduction of severe ankle fractures. J Bone Joint Surg Am 1974; 56(5): 979-993.
78. Kabukcuoglu Y, Kucukkaya M, Eren T, Gorgec M, Kuzgun U. The ANK device: a new approach in the treatment of the fractures of the lateral malleolus associated with the rupture of the syndesmosis. Foot Ankle Int 2000; 21(9): 753-758.
79. Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M. Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970-2000 and projections for the future. Bone 2002; 31(3): 430-433. (Pubitemid 35299625)
80. Kannus P, Parkkari J, Niemi S, Palvanen M. Epidemiology of osteoporotic ankle fractures in elderly persons in Finland. Ann Intern Med 1996; 125(12): 975-978. (Pubitemid 26424526)
81. Kim S K, Oh J K. One or two lag screws for fixation of Danis-Weber type B fractures of the ankle. J Trauma 1999; 46(6): 1039-1044.
82. Koval K J, Egol K A, Cheung Y, Goodwin D W, Spratt K F. Does a positive ankle stress test indicate the need for operative treatment after lateral malleolus fracture? A preliminary report. J Orthop Trauma 2007; 21(7): 449-455. (Pubitemid 47356970)
83. Koval K J, Petraco D M, Kummer F J, Bharam S. A new technique for complex fibula fracture fixation in the elderly: a clinical and biomechanical evaluation. J Orthop Trauma 1997; 11(1): 28-33. (Pubitemid 127453360)
84. Kristensen K D, Hansen T. Closed treatment of ankle fractures. Stage II supination- eversion fractures followed for 20 years. Acta Orthop Scand 1985; 56(2): 107-109. (Pubitemid 15011345)
85. Kwon J Y, Chacko A T, Kadzielski J J, Appleton P T, Rodriguez E K. A novel methodology for the study of injury mechanism: ankle fracture analysis using injury videos posted on YouTube.com. J Orthop Trauma 2010; 24(8): 477-482.
86. Lambert KL. The weight-bearing function of the fibula. A strain gauge study. J Bone Joint Surg Am 1971; 53(3): 507-513.
87. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159-74. (Pubitemid 8054849)
88. Lash N, Horne G, Fielden J, Devane P. Ankle fractures: functional and lifestyle outcomes at 2 years. ANZ J Surg 2002; 72(10): 724-730. (Pubitemid 35334896)
89. Lauge-Hansen N. Fractures of the ankle. II. Combined experimental- surgical and experimental-roentgenologic investigations. Arch Surg 1950; 60(5): 957-985.
90. Leeds H C, Ehrlich M G. Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg Am 1984; 66(4): 490-503. (Pubitemid 14136822)
91. Lehto M, Tunturi T. Improvement 2-9 years after ankle fracture. Acta Orthop Scand 1990; 61(1): 80.
92. Lindsjo U. Classification of ankle fractures: the Lauge-Hansen or AO system? Clin Orthop Relat Res 1985a;(199): 12-16. (Pubitemid 16225174)
93. Lindsjo U. Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res 1985b;(199): 28-38. (Pubitemid 16225176)
94. Lloyd S. Selective radiographic assessment of acute ankle injuries in the emergency department: barriers to implementation. CMAJ 1986; 135(9): 973-974. (Pubitemid 17177747)
95. Lundberg A. Kinematics of the ankle and foot. In vivo roentgen stereophotogrammetry. Acta Orthop Scand Suppl 1989; 233: 1-24. (Pubitemid 19275698)
96. Magid D, Michelson J D, Ney D R, Fishman E K. Adult ankle fractures: comparison of plain films and interactive two- and three-dimensional CT scans. AJR Am J Roentgenol 1990; 154(5): 1017-1023. (Pubitemid 20133957)
97. Makwana N K, Bhowal B, Harper W M, Hui A W. Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomised study. J Bone Joint Surg Br 2001; 83(4): 525-529. (Pubitemid 32496378)
98. Marsh JL, Saltzman CL. Ankle fractures. In: Rockwood and Green's Fractures in Adults. (Eds. Bucholz RW, Heckman JD). Lippincott Williams & Wilkins, Philadelphia, 2001; 2001-2090.
99. McBryde A, Chiasson B, Wilhelm A, Donovan F, Ray T, Bacilla P. Syndesmotic screw placement: a biomechanical analysis. Foot Ankle Int 1997; 18(5): 262-266. (Pubitemid 27227645)
100. Michelson J, Solocoff D, Waldman B, Kendell K, Ahn U. Ankle fractures. The Lauge- Hansen classification revisited. Clin Orthop Relat Res 1997;(345): 198-205. (Pubitemid 28007506)
101. Michelson J D. Fractures about the ankle. J Bone Joint Surg Am 1995; 77(1): 142-152.
102. Michelson J D, Hamel A J, Buczek F L, Sharkey N A. Kinematic behavior of the ankle following malleolar fracture repair in a high-fidelity cadaver model. J Bone Joint Surg Am 2002; 84-A(11): 2029-2038. (Pubitemid 35283370)
103. Michelson J D, Magid D, McHale K. Clinical utility of a stability-based ankle fracture classification system. J Orthop Trauma 2007; 21(5): 307-315. (Pubitemid 46718026)
104. Michelson J D, Magid D, Ney D R, Fishman E K. Examination of the pathologic anatomy of ankle fractures. J Trauma 1992; 32(1): 65-70.
105. Michelson J D, Varner K E, Checcone M. Diagnosing deltoid injury in ankle fractures: the gravity stress view. Clin Orthop Relat Res 2001;(387): 178-182. (Pubitemid 32510339)
106. Miller R S, Weinhold P S, Dahners L E. Comparison of tricortical screw fixation versus a modified suture construct for fixation of ankle syndesmosis injury: a biomechanical study. J Orthop Trauma 1999; 13(1): 39-42. (Pubitemid 128701901)
107. Milz P, Milz S, Steinborn M, Mittlmeier T, Putz R, Reiser M. Lateral ankle ligaments and tibiofibular syndesmosis. 13-MHz high-frequency sonography and MRI compared in 20 patients. Acta Orthop Scand 1998; 69(1): 51-55. (Pubitemid 28105162)
108. Monga P, Kumar A, Simons A, Panikker V. Management of distal tibio-fibular syndesmotic injuries: a snapshot of current practice. Acta Orthop Belg 2008; 74(3): 365-369.
109. Moore J A, Jr., Shank J R, Morgan S J, Smith W R. Syndesmosis fixation: a comparison of three and four cortices of screw fixation without hardware removal. Foot Ankle Int 2006; 27(8): 567-572. (Pubitemid 44289932)
110. Muller M, Allgower M, Schneider R, Willenegger H. Manual of Internal Fixation. Techniques Recommended by the AO Group. Springer, New York 1979.
111. Muller M, Allgower M, Schneider R, Willenegger H. In: Manual of Internal Fixation. Techniques Recommended by the AO Group. Springer, New York 1991.
112. Nelson O A. Examination and repair of the AITFL in transmalleolar fractures. J Orthop Trauma 2006; 20(9): 637-643. (Pubitemid 44706908)
113. Nielsen J O, Dons-Jensen H, Sorensen H T. Lauge-Hansen classification of malleolar fractures. An assessment of the reproducibility in 118 cases. Acta Orthop Scand 1990; 61(5): 385-387. (Pubitemid 20373918)
114. Nielson J H, Sallis J G, Potter H G, Helfet D L, Lorich D G. Correlation of interosseous membrane tears to the level of the fibular fracture. J Orthop Trauma 2004; 18(2): 68-74. (Pubitemid 38228568)
115. Nousiainen M T, McConnell A J, Zdero R, McKee M D, Bhandari M, Schemitsch E H. The influence of the number of cortices of screw purchase and ankle position in Weber C ankle fracture fixation. J Orthop Trauma 2008; 22(7): 473-478.
116. Ogilvie-Harris D J, Reed S C. Disruption of the ankle syndesmosis: diagnosis and treatment by arthroscopic surgery. Arthroscopy 1994; 10(5): 561-568. (Pubitemid 24296331)
117. Ogilvie-Harris D J, Reed S C, Hedman T P. Disruption of the ankle syndesmosis: biomechanical study of the ligamentous restraints. Arthroscopy 1994; 10(5): 558-560. (Pubitemid 24296330)
118. Olerud C. The effect of the syndesmotic screw on the extension capacity of the ankle joint. Arch Orthop Trauma Surg 1985; 104(5): 299-302. (Pubitemid 16145989)
119. Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg 1984; 103(3): 190-194. (Pubitemid 14032126)
120. Ostrum R F. Posterior plating of displaced Weber B fibula fractures. J Orthop Trauma 1996; 10(3): 199-203. (Pubitemid 126432689)
121. Ostrum R F, Litsky A S. Tension band fixation of medial malleolus fractures. J Orthop Trauma 1992; 6(4): 464-468.
122. Pankovich A M. Fractures of the fibula at the distal tibiofibular syndesmosis. Clin Orthop Relat Res 1979;(143): 138-147. (Pubitemid 10186972)
123. Pankovich A M, Shivaram M S. Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament. II. Clinical studies. Acta Orthop Scand 1979; 50(2): 225-236. (Pubitemid 9181273)
124. Peter R E, Harrington R M, Henley M B, Tencer A F. Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: comparison of two fixation techniques. J Orthop Trauma 1994; 8(3): 215-219.
125. Pettrone F A, Gail M, Pee D, Fitzpatrick T, Van Herpe L B. Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg Am 1983; 65(5): 667-677. (Pubitemid 13107125)
126. Phillips W A, Schwartz H S, Keller C S, Woodward H R, Rudd W S, Spiegel P G, Laros G S. A prospective, randomized study of the management of severe ankle fractures. J Bone Joint Surg Am 1985; 67(1): 67-78. (Pubitemid 15193001)
127. Procter P, Paul J P. Ankle joint biomechanics. J Biomech 1982; 15(9): 627-634. (Pubitemid 13219966)
128. Purvis G D. Displaced, unstable ankle fractures: classification, incidence, and management of a consecutive series. Clin Orthop Relat Res 1982;(165): 91-98. (Pubitemid 12101812)
129. Raasch W G, Larkin J J, Draganich L F. Assessment of the posterior malleolus as a restraint to posterior subluxation of the ankle. J Bone Joint Surg Am 1992; 74(8): 1201-1206.
130. Ramsey P L, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 1976; 58(3): 356-357.
131. Rasmussen O. Stability of the ankle joint. Analysis of the function and traumatology of the ankle ligaments. Acta Orthop Scand Suppl 1985; 211: 1-75.
132. Rasmussen O, Kromann-Andersen C, Boe S. Deltoid ligament. Functional analysis of the medial collateral ligamentous apparatus of the ankle joint. Acta Orthop Scand 1983; 54(1): 36-44.
133. Rasmussen S, Madsen P V, Bennicke K. Observer variation in the Lauge- Hansen classification of ankle fractures. Precision improved by instruction. Acta Orthop Scand 1993; 64(6): 693-694. (Pubitemid 24032265)
134. Rowley D I, Norris S H, Duckworth T. A prospective trial comparing operative and manipulative treatment of ankle fractures. J Bone Joint Surg Br 1986; 68(4): 610-613. (Pubitemid 16035353)
135. Ryd L, Bengtsson S. Isolated fracture of the lateral malleolus requires no treatment. 49 prospective cases of supination-eversion type II ankle fractures. Acta Orthop Scand 1992; 63(4): 443-446.
136. Sammarco G J, Burstein A H, Frankel V H. Biomechanics of the ankle: a kinematic study. Orthop Clin North Am 1973; 4(1): 75-96.
137. Sasse M, Nigg B M, Stefanyshyn D J. Tibiotalar motion - effect of fibular displacement and deltoid ligament transection: in vitro study. Foot Ankle Int 1999; 20(11): 733-737.
138. Schaffer J J, Manoli A. The antiglide plate for distal fibular fixation. A biomechanical comparison with fixation with a lateral plate. J Bone Joint Surg Am 1987; 69(4): 596-604. (Pubitemid 17086917)
139. Scheidt K B, Stiehl J B, Skrade D A, Barnhardt T. Posterior malleolar ankle fractures: an in vitro biomechanical analysis of stability in the loaded and unloaded states. J Orthop Trauma 1992; 6(1): 96-101.
140. Sclafani S J. Ligamentous injury of the lower tibiofibular syndesmosis: radiographic evidence. Radiology 1985; 156(1): 21-27. (Pubitemid 15226196)
141. Skie M C, Ebraheim N A, Woldenberg L, Randall K. Fracture of the anterior colliculus. J Trauma 1995; 38(4): 642-647.
142. Soin S P, Knight T A, Dinah A F, Mears S C, Swierstra B A, Belkoff S M. Suture-button versus screw fixation in a syndesmosis rupture model: a biomechanical comparison. Foot Ankle Int 2009; 30(4): 346-352.
143. Stark E, Tornetta P, III, Creevy W R. Syndesmotic instability in Weber B ankle fractures: a clinical evaluation. J Orthop Trauma 2007; 21(9): 643-646. (Pubitemid 47549099)
144. Stiell I G, Greenberg G H, McKnight R D, Wells G A. Ottawa ankle rules for radiography of acute injuries. N Z Med J 1995; 108(996): 111.
145. Stoffel K, Wysocki D, Baddour E, Nicholls R, Yates P. Comparison of two intraoperative assessment methods for injuries to the ankle syndesmosis. A cadaveric study. J Bone Joint Surg Am 2009; 91(11): 2646-2652.
146. Sujitkumar P, Hadfield J M, Yates D W. Sprain or fracture? An analysis of 2000 ankle injuries. Arch Emerg Med 1986; 3(2): 101-106. (Pubitemid 16099276)
147. Takao M, Ochi M, Naito K, Iwata A, Kawasaki K, Tobita M, Miyamoto W, Oae K. Arthroscopic diagnosis of tibiofibular syndesmosis disruption. Arthroscopy 2001; 17(8): 836-843.
148. Takao M, Ochi M, Oae K, Naito K, Uchio Y. Diagnosis of a tear of the tibiofibular syndesmosis. The role of arthroscopy of the ankle. J Bone Joint Surg Br 2003; 85(3): 324-329. (Pubitemid 36511577)
149. Teitz C C, Harrington R M. A biochemical analysis of the squeeze test for sprains of the syndesmotic ligaments of the ankle. Foot Ankle Int 1998; 19(7): 489-492. (Pubitemid 28347710)
150. Thompson M C, Gesink D S. Biomechanical comparison of syndesmosis fixation with 3.5-and 4.5-millimeter stainless steel screws. Foot Ankle Int 2000; 21(9): 736-741.
151. Thomsen N O, Overgaard S, Olsen L H, Hansen H, Nielsen S T. Observer variation in the radiographic classification of ankle fractures. J Bone Joint Surg Br 1991; 73(4): 676-678.
152. Thordarson D B, Samuelson M, Shepherd L E, Merkle P F, Lee J. Bioabsorbable versus stainless steel screw fixation of the syndesmosis in pronationlateral rotation ankle fractures: a prospective randomized trial. Foot Ankle Int 2001; 22(4): 335-338. (Pubitemid 32405857)
153. Tornetta P, III. Competence of the deltoid ligament in bimalleolar ankle fractures after medial malleolar fixation. J Bone Joint Surg Am 2000; 82(6): 843-848.
154. Tornetta P, III, Creevy W. Lag screw only fixation of the lateral malleolus. J Orthop Trauma 2001; 15(2): 119-121. (Pubitemid 33599814)
155. Tornetta P, III, Spoo J E, Reynolds F A, Lee C. Overtightening of the ankle syndesmosis: is it really possible? J Bone Joint Surg Am 2001; 83-A(4): 489-492. (Pubitemid 32294928)
156. Treadwell J R, Fallat L M. The antiglide plate for the Danis-Weber type-B fibular fracture: a review of 71 cases. J Foot Ankle Surg 1993; 32(6): 573-579. (Pubitemid 24021146)
157. Tunturi T, Kemppainen K, Patiala H, Suokas M, Tamminen O, Rokkanen P. Importance of anatomical reduction for subjective recovery after ankle fracture. Acta Orthop Scand 1983; 54(4): 641-647. (Pubitemid 13039101)
158. van den Bekerom M P, Haverkamp D, Kerkhoffs G M, van Dijk C N. Syndesmotic stabilization in pronation external rotation ankle fractures. Clin Orthop Relat Res 2010; 468(4): 991-995.
159. van Laarhoven C J, Meeuwis J D, van d W. Postoperative treatment of internally fixed ankle fractures: a prospective randomised study. J Bone Joint Surg Br 1996; 78(3): 395-399.
160. van Staa T P, Dennison E M, Leufkens H G, Cooper C. Epidemiology of fractures in England and Wales. Bone 2001; 29(6): 517-522. (Pubitemid 33124293)
161. Vangsness C T, Jr., Carter V, Hunt T, Kerr R, Newton E. Radiographic diagnosis of ankle fractures: are three views necessary? Foot Ankle Int 1994; 15(4): 172-174. (Pubitemid 24130790)
162. Vogl T J, Hochmuth K, Diebold T, Lubrich J, Hofmann R, Stockle U, Sollner O, Bisson S, Sudkamp N, Maeurer J, Haas N, Felix R. Magnetic resonance imaging in the diagnosis of acute injured distal tibiofibular syndesmosis. Invest Radiol 1997; 32(7): 401-409. (Pubitemid 27421990)
163. Weber M, Burmeister H, Flueckiger G, Krause F G. The use of weightbearing radiographs to assess the stability of supination-external rotation fractures of the ankle. Arch Orthop Trauma Surg 2010; 130(5): 693-698.
164. Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma 2005; 19(2): 102-108. (Pubitemid 40340218)
165. Wikeroy A K, Hoiness P R, Andreassen G S, Hellund J C, Madsen J E. No difference in functional and radiographic results 8.4 years after quadricortical compared with tricortical syndesmosis fixation in ankle fractures. J Orthop Trauma 2010; 24(1): 17-23.
166. Winkler B, Weber B G, Simpson L A. The dorsal antiglide plate in the treatment of Danis-Weber type-B fractures of the distal fibula. Clin Orthop Relat Res 1990;(259): 204-209. (Pubitemid 20336121)
167. Wiss D. In: Master Techniques in Orthopaedic Surgery. Fractures. Lippincott Williams & Wilkins, Philadelphia, 2006; 2: 551-567.
168. Wuest T K. Injuries to the Distal Lower Extremity Syndesmosis. J Am Acad Orthop Surg 1997; 5(3): 172-181.
169. Xenos J S, Hopkinson W J, Mulligan M E, Olson E J, Popovic N A. The tibiofibular syndesmosis. Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. Bone Joint Surg Am 1995; 77(6): 847-856.
170. Yablon I G, Heller F G, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg Am 1977; 59(2): 169-173. (Pubitemid 8067248)
171. Yamaguchi K, Martin C H, Boden S D, Labropoulos P A. Operative treatment of syndesmotic disruptions without use of a syndesmotic screw: a prospective clinical study. Foot Ankle Int 1994; 15(8): 407-414. (Pubitemid 24259060)
172. Yde J, Kristensen K D. Ankle fractures. Supination-eversion fractures stage II. Primary and late results of operative and non-operative treatment. Acta Orthop Scand 1980a; 51(4): 695-702.
173. Yde J, Kristensen K D. Ankle fractures: supination-eversion fractures of stage IV. Primary and late results of operative and non-operative treatment. Acta Orthop Scand 1980b; 51(6): 981-990. (Pubitemid 11146075)
174. Zeegers A V, Van Raay J J, van der Werken C. Ankle fractures treated with a stabilizing shoe. Acta Orthop Scand 1989; 60(5): 597-599. (Pubitemid 20011037)