Incidence of syndesmotic injuries in all different types of ankle fractures

Aim: To determine the incidence of syndesmotic injuries in ankle fractures within the division of Orthopaedic Surgery, University of Pretoria. Methods: A total of 94 serial patients with ankle fractures were assessed for syndesmotic injury by means of ankle mortise stress views and manual traction with a bone hook. Each fracture was classified according to both the Weber and Lauge Hansen classification and the incidence of syndesmosis injury in each group was determined. Results: In total, 94 patients were evaluated over a 6-month period. There were 54 males and 40 females. The mean age was 39.3 years with a range of 13 to 85 years. An overall incidence of syndesmotic injuries of 32.97% (31 injuries) was found in our series. Of these 31 syndesmotic injuries 3% were Weber A, 29% Weber B, 65% Weber C, and 3% were isolated medial-malleolus fractures. According to the Lauge-Hansen classification, 3% were abduction injuries, 61% pronation-external rotation, 29% supination-external rotation and 7% verticalcompression dorsiflexion injuries. Conclusion: The overall incidence of 33% of syndesmotic injuries was much higher than expected. Due to the fact that an incidence of 3% in Weber A fractures and 29% in Weber B fractures was found, we suggest that all types of ankle fractures should be stressed in theatre.