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![]() Patients with displaced ILMFs without apparent TS in diagnostic non-weightbearing, non-stressed radiographs could thus be described as “potentially stable". Deltoid ligament incompetence can result in lateral displacement of the talus, defined as talar shift (TS), leading to altered ankle joint kinematics. The medial deltoid ligament complex is believed to be the most important stabilizing structure in ILMFs. Fibular fracture displacement alone does not seem to be a predictor of pathological ankle joint kinematics after injury. A survey study showed that 91% of the responding surgeons stated fibular displacement as critical when deciding between surgical and non-operative ILMF treatment. In clinical practice, many orthopedic surgeons continue to use the degree of fibular fracture displacement as an indication for surgery. Surgical fixation of ILMFs carries a risk of severe AEs and many patients will require subsequent implant removal procedures. A growing body of the literature supports treating stable ILMFs non-operatively. ILMFs are the most common type of ankle fracture. Our hypothesis was that a substantial proportion of patients with “potentially stable” fractures could have been managed non-operatively if a preoperative stress-test had been performed to determine stability. In this study, we retrospectively applied the stability-based classification system to a cohort of 1006 patients with ankle fractures treated surgically to identify patients with “potentially stable” displaced isolated lateral malleolar fractures (ILMF) according to these stability criteria. According to the stability-based classification, an ankle fracture should be considered stable if it does not require reduction, is unimalleolar, and shows sufficient ligamentous integrity to secure anatomical alignment of the talus under the tibia. describes an algorithm to differentiate unstable ankle fractures, which should be treated surgically, from stable fractures, which should be treated non-operatively. The stability-based classification system by Michelson et al. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.ĭiagnosing clinically relevant instability is key when treating isolated lateral malleolar fractures. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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