patterns of ankle fractures based on radiographs and ct images of 1000 consecutive patients

Objectives: the knowledge of different types of ankle fractures based on plain radiographs and computed tomography (ct) images can help improve patients’ management.methods: this cross-sectional study assessed the plain radiographs and ct images of 1,000 consecutive patients observed in an emergency department between march 2015 and march 2020. fractures were labeled as uni-, bi-, or trimalleolar. malleolar fractures were classified into medial, lateral, and posterior ones based on herscovici, danisweber, and mason and molloy classifications, respectively. bi- and trimalleolar fractures, on the other hand, were categorized according to the lauge-hansen classification.results: this study included 1,000 patients with 1,003 ankle fractures. of them, 901 were adults (mean±sd age: 41.6±16.7, male: 567 [62.9%]) with 904 fractures. in total, 53% of adult patients were 18 to 39 years old. considering unilateral ankle fractures, the medial malleolar fracture was the most common unimalleolar fracture (62.6%), with herscovici c being the most frequent subtype (65.3%). on the other hand, the most common type of lateral malleolar fracture was danis-weber type b (65.5%). there were also 209 (23.3%) bimalleolar and 114 (12.7%) trimalleolar fractures, 5.8% (16 fractures) of which could not be classified based on the lauge-hansen classification. unimalleolar fractures were also observed in 87 (87.9%) children, with the medial malleolar fracture being the most common type (89.7%).conclusion: medial malleolar fractures were the most frequent malleoli in patients observed in the emergency department under study. among bi- and trimalleolar ankle fractures, supination-external rotation and pronationexternal rotation injuries were the most common patterns. the lauge-hansen classification was not applicable in 5.8% of bi- and trimalleolar fractures. level of evidence: iv