Supination adduction stage 2 associated with transverse fracture of the lateral malleolus and rupture of the anterior talofibular ligament: a case report and literature review.
Jingxuan Wang, Kangyong Yang, Zhenjiang Liu, Ke Jie, Biqing Huang, Shiheng Wang, Zhihong Mo, Yunxuan Zou
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引用次数: 0
Abstract
Background: Supination-adduction (SAD) type ankle fractures occur when the ankle is subjected to inversion forces while in a supinated position, leading to transverse fractures of the lateral malleolus or lateral ligament injuries, often accompanied by vertical fractures of the medial malleolus. Unlike the typical SAD pattern, the concurrent occurrence of a transverse lateral malleolus fracture combined with rupture of the Anterior Talofibular Ligament (ATFL) is uncommon and has not been reported in the literature; such injuries are frequently missed in clinical practice, which in turn affects clinicians' treatment decisions and the recovery of ankle joint stability and function.
Case presentation: This report describes a case of an adult Asian female patient who sustained a left ankle injury due to a missed step, resulting in swelling and pain. The initial diagnosis was a left double ankle fracture (SAD stage 2). During surgery, after stabilizing the medial and lateral malleoli, fluoroscopy revealed that the talus could not be reduced. An extended incision identified the ATFL rupture, which was subsequently repaired using the Broström-Gould technique. Post-repair fluoroscopy confirmed satisfactory reduction of the talus and proper alignment of the ankle joint. After two weeks of cast immobilization, the patient began gradual rehabilitation exercises. At the 18-month follow-up, the patient exhibited good ankle function, achieving an American Orthopaedic Foot and Ankle Society Ankle - Hindfoot Scale of 100.
Conclusion: This report shares the clinical experience in diagnosing and treating occult injuries of the ATFL in a case of SAD stage 2 ankle fracture to enhance awareness and prevent missed diagnoses in similar injuries. We emphasize that in SAD stage 2 fractures showing unexplained talar tilt after fixation, clinicians should suspect and evaluate for occult ATFL injury to avoid missed diagnoses and optimize treatment decisions.
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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