Ankle fracture spur sign is pathognomonic for a variant ankle fracture.

Abstract:

BACKGROUND:The hyperplantarflexion variant ankle fracture is composed of a posterior tibial lip fracture with posterolateral and posteromedial fracture fragments separated by a vertical fracture line. This infrequently reported injury pattern often includes an associated "spur sign" or double cortical density at the inferomedial tibial metaphysis. The objective of this study was to quantitatively establish the association of the ankle fracture spur sign with the hyperplantarflexion variant ankle fracture. METHODS:Our clinical database of operative ankle fractures was retrospectively reviewed for the incidence of hyperplantarflexion variant and nonvariant ankle fractures as determined by assessment of injury radiographs, preoperative advanced imaging, and intraoperative observation. Injury radiographs were then evaluated for the presence of the spur sign, and association between the spur sign and variant fractures was analyzed. RESULTS:The incidence of the hyperplantarflexion variant fracture among all ankle fractures was 6.7% (43/640). The spur sign was present in 79% (34/43) of variant fractures and absent in all nonvariant fractures, conferring a specificity of 100% in identifying variant fractures. Positive predictive value and negative predictive value were 100% and 99%, respectively. CONCLUSION:The ankle fracture spur sign was pathognomonic for the hyperplantarflexion variant ankle fracture. It is important to identify variant fractures preoperatively as patient positioning, operative approach, and fixation construct of variant fractures often differ from those employed for osteosynthesis of nonvariant fractures. Identification of the spur sign should prompt acquisition of advanced imaging to formulate an appropriate operative plan to address the variant fracture pattern. LEVEL OF EVIDENCE:Level III, retrospective comparative study.

journal_name

Foot Ankle Int

authors

Hinds RM,Garner MR,Lazaro LE,Warner SJ,Loftus ML,Birnbaum JF,Burket JC,Lorich DG

doi

10.1177/1071100714553470

subject

Has Abstract

pub_date

2015-02-01 00:00:00

pages

159-64

issue

2

eissn

1071-1007

issn

1944-7876

pii

1071100714553470

journal_volume

36

pub_type

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