A Prospective Study of Utility of Weight Bearing X-Rays in Aiding the Management of Isolated Lateral Malleolar Fractures

INTRODUCTION: Fractures of Ankle constitute about 10% of all fractures. This makes ankle fractures second most common fracture of lower limb next only to hip fractures and Isolated Lateral Malleolar fractures are the most common of ankle fractures. These injuries have a bimodal distribution, peaking in younger men and older women. These are typically low energy injuries, majority of which are caused by selffall followed by sports injuries and road traffic accidents. All of these injuries, which produce a twisting force on ankle, is the main factor in causation of ankle fractures. Even open ankle fractures are low energy Fractures usually seen in elderly Women and those who are obese. Injuries of ankle joint can cause destruction of bony elements, ligamentous components or both. Though not associated with low bone mineral density, these fractures occur in elderly patients in whom the microarchitecture of trabecular bone is abnormal with depleted bone mineral density, when compared to uninjured controls. AIM OF THE STUDY: 1. The purpose of this study is to determine the utility of weight bearing x-rays to assess the integrity of deltoid ligament in isolated lateral malleolar fractures and thereby the need for surgery. 2. To assess the functional outcomes of conservatively managed lateral malleolar fractures. MATERIALS AND METHODS: This prospective study was done at Rajiv Gandhi Government General Hospital, Chennai. In our study, 19 cases of isolated lateral malleolus fractures were analyzed. Classification used was Lauge-Hansen and Denis Weber classification. Patients were managed conservatively in Below Knee Plaster of Paris Slab. Regular Follow Up once in 3 weeks and if any symptoms develop in between for 2 months and then once a month for 4 months. Radiological union, Functional outcome, Patient Satisfaction measured using AOFAS Score. RESULTS: 11% of isolated Lateral malleolus fractures were found to be unstable in our protocol following use of Weight bearing Radiographs. Results were analyzed using AOFAS (American Orthopaedic Foot and Ankle) Score. Patients chosen for Conservative management using Weight bearing Radiographs had an excellent Score of 93 in our study. CONCLUSION: The protocol followed in our study was found to be easy, safe and reliable method with better patient compliance to choose between operative and non-operative treatment. Patients Managed conservatively using our protocol had Excellent outcome scores