Zusammenfassung
Hintergrund
Die Kenntnis über den Entstehungsmechanismus und das detaillierte Ausmaß einer Sprunggelenkverletzung bedingen deren adäquate Behandlung.
Material und Methoden
Supinations-Eversions- (SE-) Verletzungen wurden in 29 Unterschenkelpräparaten induziert und deren Knochendichte bestimmt. Die Literaturrecherche umfasst die experimentellen Arbeiten über diese Verletzungsentität.
Ergebnisse
Wir konnten das Stadium II der Verletzung in 42% induzieren; die Inzidenz konnte durch ein laterales Widerlager erhöht werden. In 50% blieb die Syndesmose bei induzierter Fibulafraktur auf Syndesmosenhöhe intakt. Das Stadium IV wurde in 25% beobachtet. Die insgesamt geringe Knochendichte zeigte eine positive Korrelation zum Entstehungswinkel der Fibulafraktur.
Schlussfolgerung
Wir haben SE-Verletzungen in osteoporotischen Unterschenkelpräparaten induziert. Im Stadium II der Verletzung war die vordere untere tibiofibulare Syndesmose in 50% der Experimente intakt. Innenknöchelfrakturen konnten erstmals nach Lauge-Hansen und Michelson reproduziert werden. Etablierte Frakturmodelle liefern Erkenntnisse über die Pathogenese der Verletzung und sind für die biomechanische Implantattestung essentiell.
Abstract
Background
Knowledge of the pathomechanism and the detailed extent of ankle joint lesions determines adequate therapy and success of treatment.
Material and methods
Supination external rotation lesions were induced in 29 human cadavera with a testing apparatus; 27 of these specimens were from elderly women. Bone mineral density was measured. The literature review includes experimental studies of this fracture entity.
Results
We induced stage II in 42%; applying an additional lateral force on the fibula raised the incidence. The syndesmosis stayed intact in 50% although the fibula fractured at the level of the tibial plafond. Stage IV lesions were registered in 25%. The overall low bone mineral density showed a positive correlation to the angle at which the fibula fracture occurred.
Conclusions
We reproduced supination external rotation lesions according to Lauge-Hansen in osteoporotic ankles. There is a certain discrepancy between the obligatory lesion of the inferior anterior tibiofibular syndesmosis at stage II according to Lauge-Hansen, as we observed an intact syndesmosis in 50% at stage II. Stage IV defining medial malleolar fractures were reproduced after Lauge-Hansen and Michelson et al.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Cedell CA (1967) Supination-outward rotation injuries of the ankle. A clinical and roentgenological study with special reference to the operative treatment. Acta Orthop Scand 110(Suppl):113
Dattani R, Patnaik S, Kantak A et al (2008) Injuries to the tibiofibular syndesmosis. J Bone Joint Surg Br 90:405–410
De Souza Dias L, Foerster TP (1974) Traumatic lesions of the ankle joint. The supination-external rotation mechanism. Clin Orthop Relat Res 100:219–224
Girschick HJ, Haubitz I, Hiort O, Schneider P (2007) Long-term follow-up of bone mineral density in childhood hypophosphatasia. Joint Bone Spine 74:263–269
Haraguchi N, Armiger RS (2009) A new interpretation of the mechanism of ankle fracture. J Bone Joint Surg Am 91:821–829
Hirsch C, Lewis J (1965) Experimental ankle-joint fractures. Acta Orthop Scand 36:408–417
Lauge-Hansen N (1952) Fractures of the ankle IV. Clinical use of genetic roentgen diagnosis and genetic reduction. Arch Surg 64:488
Lauge-Hansen N (1948) Fractures of the ankle. I. Analytical Historical survey as the basis of new experimental, roentgenological and clinical investigations. Arch Surg 56:259–317
Lauge-Hansen N (1950) Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg 60:957–985
Markolf KL (1989) Torsional strength of the ankle in vitro – the supination external rotation injury. Clin Orthop Relat Res 246:266–272
Michelson JD (1997) Ankle fractures – the Lauge-Hansen classification revisited. Clin Orthop Relat Res 345:198–205
Michelson JD (1995) Fractures about the ankle. J Bone Joint Surg Am 77:142–152
Ochman S, Doht S, Paletta J et al (o J) Comparison between locking and non-locking plates for fixation of metacarpal fractures in an animal model. J Hand Surg Am 35:597–603
Rammelt S (2004) Anatomie, Biomechanik und Klassifikation der Sprunggelenkfrakturen. Trauma Berufskrankheit 6:384–392
Rammelt S, Grass R, Zwipp H (2008) Ankle fractures. Unfallchirurg 111:421–438
Schaffer J, Manoli A (1987) The antiglide plate for distal fibular fixation. A biomechanical comparison with fixation with a lateral plate. J Bone Joint Surg Am 69:596-604
Schneider P, Butz S, Allolio B et al (1995) Multicenter German reference data base for peripheral quantitative computer tomography. Technol Health Care 3:69–73
Shariff SS (2006) Lauge-Hansen classification – a literature review. The International journal of the care of the injured. Injury 37:888–890
SooHoo NF, Krenek L, Eagan MJ et al (2009) Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg Am 91:1042–1049
Stiehl JB (1992) Experimentally produced ankle fractures in autopsy specimens. Clin Orthop Relat Res 285:244–249
Yde J (1980) The Lauge Hansen classification of malleolar fractures. Acta Orthop Scand 51:181–192
Danksagung
Die Autoren bedanken sich bei Herrn cand. med. Alexander Sauer für die Assistenz im Rahmen der Laborarbeit.
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Zahn, R., Frey, S., Moritz, M. et al. Die Supinations-Eversions-Verletzung des OSG in osteoporotischen Unterschenkelpräparaten. Unfallchirurg 114, 697–704 (2011). https://doi.org/10.1007/s00113-011-2004-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00113-011-2004-z