[Fracture-dislocations of the ankle joint in adults. Part I: epidemiologic evaluation of patients during a 1-year period].

PURPOSE OF THE STUDY: The aim of the study is to present a basic statistical overview of fracture-dislocations of the ankle in adults in a one-year group of patients. MATERIAL: The analyzed group of patients comprised 232 patients (121 men, 111 women) treated for fracture-dislocations of the ankle at the authors' department between 1 January and 31 December 1999. In all patients the physes were closed. The type of fractures was classified after B. G. Weber.
RESULTS: Type A fractures accounted for 23%, Type B fractures for 65% and Type C fractures for 12% of all cases. The average age of the injured was 49 years (range, 16-89), with men prevailing until 5th decade and women predominating from 6th decade. In 65% of Type A fractures there occurred only the fracture of lateral malleolus, in 31% the fracture involved also medial malleolus and in 4% it affected also the posterior margin of the distal tibia. In 49% of Weber B type of fractures the medial malleolus was fractured, in 20% the deltoid ligament was ruptured and in 31% there occurred no injury on the medial aspect. Avulsion of the posterior margin of the distal tibia occurred in 46%. In 71% of Type C fractures the fracture was located in the lower half of fibula, Maisonneuve type occurred in 29%. Medial malleolus was fractured in 57%, the deltoid ligament was ruptured in 36%, in 7% there was no medial injury. The posterior margin of the distal tibia was avulsed also in 46%. Fracture of the posterior margin of the distal tibia occurred in Type A in 4%, in Type B in 46% and in Type C also in 46%. In Types B and C the size of the avulsed posterior part of the distal tibia covered 1/4 of its articular surface in 75% of cases, 1/3 in 17% and 1/2 in 8% of cases. DISCUSSION: We have found an adequate group of patients for comparison only in the Lindsjö work who evaluated a group of adult patients treated at his department between the beginning of February 1972 and end of June 1975. Other groups of patients which we studied and which included some of the parameters that we have examined are not comparable from the viewpoint of the basic selection of patients as the selection was made in a different way, namely according to the manner of treatment, i.e. conservatively or surgically, or according to the preference of one of the types of the fractures or the period of follow-up. Also, the so called epidemiological studies concentrated only on one or two factors (men/women ratio, the cause of injury, the period of the year). In addition, some works also include fractures in growing individuals.
CONCLUSION: Fracture-dislocations affect equally men and women. Men prevail until the age of fifty, women afterwards. The average age of patients was 49 years. Most frequent is Weber B Type, least frequent Weber C.