Bilateral simultaneous rotational ankle fractures: case series and literature review

Authors

  • Bander S. Alrashedan Department of Orthopedic Surgery, King Saud Medical City, Ulaishah, 7790 Al Imam Abdul Aziz Ibn Muhammad Ibn Saud, Riyadh, Saudi Arabia
  • Elham A. Alghamdi Department of Orthopedic Surgery, King Saud Medical City, Ulaishah, 7790 Al Imam Abdul Aziz Ibn Muhammad Ibn Saud, Riyadh, Saudi Arabia
  • Norah I. Alromaih Department of Orthopedic Surgery, King Saud Medical City, Ulaishah, 7790 Al Imam Abdul Aziz Ibn Muhammad Ibn Saud, Riyadh, Saudi Arabia

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20231185

Keywords:

Bilateral ankle fractures, Bilateral bimalleolar fracture, Bilateral trimalleolar fracture, Rotational Ankle Injuries

Abstract

Bilateral Simultaneous rotational ankle injuries are rare entities with little number of cases reported in literature. Unlike axial type ankle fractures, they tend to happen as a result of pivoting trauma on the supportive limb. We conducted a case series and literature review of patients who presented with simultaneous bilateral ankle injuries and discussed their presentation and imaging. A total of Four cases in our institute and 6 separate cases reported in literature were found who sustained bilateral simultaneous rotational ankle fractures. There were 10 cases, nine of which were simultaneous and symmetrical ankle injuries. Injuries found were; Maisonneuve fracture, Tillaux fracture, Syndesmotic injury, Lauge-Hansen’s supination external rotation (SER), pronation external rotation (PER), supination adduction (SAD), and pronation abduction (PA). Four cases were presented in our institute over the last 10 years. A single case was asymmetrical in nature given the presence of an associated distal tibial metaphyseal fracture. Bilateral rotational ankle injuries are rare entity presenting simultaneously unlike axial type ankle fractures. When they present, they are likely caused by higher mechanism of injury than typical unilateral rotational ankle fractures. SER injuries are the most commonly found mechanism in both unilateral and bilateral ankle injuries.

 

References

Ramos LS, Gonçalves HM, Freitas A, Oliveira MP, Lima DMS, Carmargo WS. Evaluation of the Reproducibility of Lauge-Hansen, Danis-Weber, and AO Classifications for Ankle Fractures. Rev Bras Ortop (Sao Paulo). 2021;56(3):372-8.

Zhang X, Xie P, Shao W, Xu M, Xu X, Yin Y, et al. Establishment of a finite element model of supination-external rotation ankle joint injury and its mechanical analysis. Sci Rep. 2022;12(1):20115.

Lehtola R, Leskelä HV, Flinkkilä TE, Pakarinen HJ, Niinimäki JL, Ohtonen PP, et al Syndesmosis fixation in supination-external rotation ankle fractures. Long-Term results of a prospective randomised study. Foot Ankle Surg. 2022;28(2):229-34.

Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures: an MRI study. J Orthop Trauma. 2006;20(4):267-72.

Shariff SS, Nathwani DK. Lauge-Hansen classification - a literature review. Injury. 2006;37(9):888-90.

Haapamaki VV, Kiuru MJ, Koskinen SK. Ankle and foot injuries: analysis of MDCT findings. AJR Am J Roentgenol. 2004;183(3):615-22.

Tiedeken NC, Hampton D, Shaffer G. Landing on your own two feet: a case report of bilateral calcaneus and open pilon fractures. J Foot Ankle Surg. 2014;53(5): 647-51

Dubin JC, Comeau D, McClelland RI, Dubin RA, Ferrel E. Lateral and syndesmotic ankle sprain injuries: a narrative literature review. J Chiropr Med. 2011; 10(3):204-19.

Halabchi F, Hassabi M. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop. 2020;11(12):534-58.

Atıcı Y, Üzümcügil O, Yalçınkaya M, Atıcı A, Kabukçuoğlu YS, Öztürkmen Y. Gebe hastada iki taraflı travmatik bimalleoler ayak bileği kırığı tedavisi: Olgu sunumu Treatment of a pregnant patient with bilateral traumatic bimalleolar ankle fracture: a case report. Eklem Hastalik Cerrahisi. 2013;24(1):53-7.

Dienstknecht T, Horst K, Pape HC. A 72-year-old patient with bilateral Maisonneuve fractures. Clin Pract. 2012;2(3):e72.

Kang L, Helms E, Broadhead M. Bilateral ankle syndesmosis injury: a rare case report. Orthop Rev (Pavia). 2022;14(3):35494.

Nagasawa H, Miyakoshi N, Kasukawa Y, Takeshima M, Shimada Y. Symmetrical Trimalleolar Fractures of the Bilateral Ankles: A Case Report. J Med Cases. 2012.

Rosenbaum AJ, Abousayed M, Czajka CM, DiPreta JA, Alfred R, Uhl RL. Bilateral distal tibial transitional ankle fractures. Orthopedics. 2014;37(12):853-5.

Sultan A, Shabir M, Mehmood M, Manzoor QW. Simultaneous Symmetrical Bilateral Bimalleolar Open Fracture with Ankle Dislocation by Indirect Injury - Case Study. Ortop Traumatol Rehabil. 2018;20(1):51-5.

Dhillon MS, Kumar P, John R, Hooda A. Bilateral quadriceps rupture in an elite weight lifter: a case report and review of literature. Indian J Orthop. 2020;54(3):339-47.

Okanobo H, Khurana B, Sheehan S, Duran-Mendicuti A, Arianjam A, Ledbetter S. Simplified diagnostic algorithm for Lauge-Hansen classification of ankle injuries. Radiographics. 2012;32(2):71-84.

Haraguchi N, Armiger RS. A new interpretation of the mechanism of ankle fracture. J Bone Joint Surg Am. 2009;91(4):821-9.

Bartoníček J, Rammelt S, Kašper Š, Malík J, Tuček M. Pathoanatomy of Maisonneuve fracture based on radiologic and CT examination. Arch Orthop Trauma Surg. 2019;139(4):497-506.

Dattani R, Patnaik S, Kantak A, Srikanth B, Selvan TP. Injuries to the tibiofibular syndesmosis. J Bone Joint Surg Br. 2008;90(4):405-10.

Koury SI, Stone CK, Harrell G, La Charité DD. Recognition and management of Tillaux fractures in adolescents. Pediatr Emerg Care. 1999;15(1):37-9.

Pakarinen HJ, Flinkkilä TE, Ohtonen PP, Hyvönen PH, Lakovaara MT, Leppilahti JI, Ristiniemi JY. Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study. Foot Ankle Int. 2011;32(12):1103-9.

Haller JM, Ross H, Jacobson K, Ou Z, Rothberg D, Githens M. Supination adduction ankle fractures: Ankle fracture or pilon variant?. Injury. 2020;51(3):759-63.

Downloads

Published

2023-04-28

Issue

Section

Case Series