{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T15:43:13Z","timestamp":1761061393757,"version":"3.41.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>To evaluate and compare radiographic findings in supination external (SE)<jats:sup>2<\/jats:sup> injuries versus stress (+) SE4 injuries.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Academic Level 1 trauma center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients:<\/jats:title>\n            <jats:p>The study included 350 skeletally mature patients at a single Level 1 trauma center who presented with an isolated, Lauge-Hansen type supination-external rotation pattern, Weber B lateral malleolar fracture, OTA\/AO 44-B.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>We reviewed 350 patients (185 men and 165 women), 18\u201395 years of age (avg 45), with isolated SE pattern lateral malleolar fractures. One hundred nine had SE4 injuries [medial clear space (MCS) = 8.3 mm]. Two hundred forty-one ankles were stressed; 164 were unstable and 77 were stable (SE2). Avg MCS at presentation and on stress radiographs was 3.59 mm for the SE2 (no widening) and 3.86 mm and 5.94 mm for the stress (+) SE4 group, respectively. The fibular displacement for the SE2, stress (+) SE4, and SE4 groups was 1.5 (0\u20134.5), 3.5 (0\u20136.6), and 4.1 (0\u201330.5), respectively. Sixteen of the 77 (20%) SE2 and 24 of the 164 (15%) stress (+) SE4 fractures had no displacement of the fibula on the lateral view. Similarly, 53 of the 77 (68%) SE2 and 91 of the 164 (55%) stress (+) SE4 had \u22642 mm of fibular displacement Fibular displacement of \u22642 mm on the lateral radiograph corresponded with 0.69 sensitivity and only 0.37 positive predictive value for stable ankle mortise on stress examination.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Previous work indicated that patients with an isolated SE pattern fibula fracture, a normal MCS, and \u22642 mm of fibular displacement on the lateral radiograph have a high rate of ankle stability, with a positive predictive value of approximately 97%. We were unable to confirm this finding because 15% of unstable ankles had 0 mm and 55% had \u22642 mm of fibular displacement. We conclude that stability may not be inferred from a lack of fibular displacement on the lateral view in this population of patients. If stability is to be determined, it must be tested irrespective of fibular displacement on the lateral radiograph.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000002139","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T13:08:55Z","timestamp":1619010535000},"page":"e1-e5","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Lack of Displacement of the Fibula Is Not a Confirmation of Ankle Stability in Supination External Pattern Ankle Fractures"],"prefix":"10.1097","volume":"36","author":[{"given":"Amir A.","family":"Shahien","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Tornetta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"issue":"10 suppl","key":"R1-20250614","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","article-title":"Fracture and dislocation classification compendium\u20142007: Orthopaedic Trauma Association classification, database and outcomes committee","volume":"21","author":"Marsh","year":"2007","journal-title":"J Orthop Trauma."},{"key":"R2-20250614","first-page":"544","article-title":"Ligamentous ankle fractures; diagnosis and treatment","volume":"97","author":"Lauge-Hansen","year":"1949","journal-title":"Acta Chir Scand."},{"key":"R3-20250614","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1001\/archsurg.1950.01250010980011","article-title":"Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations","volume":"60","author":"Lauge-Hansen","year":"1950","journal-title":"Arch Surg."},{"key":"R4-20250614","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/BOT.0b013e318059aea3","article-title":"Clinical utility of a stability-based ankle fracture classification system","volume":"21","author":"Michelson","year":"2007","journal-title":"J Orthop Trauma."},{"key":"R5-20250614","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1007\/s00167-016-4017-1","article-title":"Conservative and surgical management of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines","volume":"24","author":"van Dijk","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"R6-20250614","doi-asserted-by":"crossref","first-page":"2393","DOI":"10.2106\/00004623-200411000-00005","article-title":"Ankle stress test for predicting the need for surgical fixation of isolated fibular fractures","volume":"86-a","author":"Egol","year":"2004","journal-title":"J Bone Joint Surg Am."},{"key":"R7-20250614","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.2106\/00004623-200410000-00007","article-title":"Stress examination of supination external rotation-type fibular fractures","volume":"86-a","author":"McConnell","year":"2004","journal-title":"J Bone Joint Surg Am."},{"key":"R8-20250614","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/BOT.0b013e3180413835","article-title":"Does medial tenderness predict deep deltoid ligament incompetence in supination-external rotation type ankle fractures?","volume":"21","author":"DeAngelis","year":"2007","journal-title":"J Orthop Trauma."},{"key":"R9-20250614","doi-asserted-by":"crossref","first-page":"482","DOI":"10.2106\/JBJS.16.00450","article-title":"Dynamic stress testing is unnecessary for unimalleolar supination-external rotation ankle fractures with minimal fracture displacement on lateral radiographs","volume":"99","author":"Nortunen","year":"2017","journal-title":"J Bone Joint Surg Am."},{"key":"R10-20250614","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1097\/BOT.0b013e31825cf39c","article-title":"Treatment of the stress positive ligamentous SE4 ankle fracture: incidence of syndesmotic injury and clinical decision making","volume":"26","author":"Tornetta","year":"2012","journal-title":"J Orthop Trauma."},{"key":"R11-20250614","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.2106\/JBJS.16.01416","article-title":"Which Lateral Malleolar Fractures Do Not Need an Operation?: commentary on an article by Simo Nortunen, MD, et al.: Dynamic Stress Testing Is Unnecessary for Unimalleolar Supination-External Rotation Ankle Fractures with Minimal Fracture Displacement on Lateral Radiographs","volume":"99","author":"Marsh","year":"2017","journal-title":"J Bone Joint Surg Am."},{"key":"R12-20250614","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/BOT.0000000000000785","article-title":"Serial radiographs do not change the clinical course of nonoperative stable OTA\/AO 44-B1 ankle fractures","volume":"31","author":"Marchand","year":"2017","journal-title":"J Orthop Trauma."},{"key":"R13-20250614","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/BOT.0b013e3182460837","article-title":"Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial","volume":"26","author":"Sanders","year":"2012","journal-title":"J Orthop Trauma."},{"key":"R14-20250614","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.2106\/JBJS.M.00709","article-title":"Preoperative radiographic and CT findings predicting syndesmotic injuries in supination-external rotation-type Ankle fractures","volume":"96","author":"Choi","year":"2014","journal-title":"J Bone Joint Surg Am."},{"key":"R15-20250614","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1053\/j.jfas.2015.04.025","article-title":"Weightbearing radiographs facilitate functional treatment of ankle fractures of uncertain stability","volume":"54","author":"Hastie","year":"2015","journal-title":"J Foot Ankle Surg."},{"key":"R16-20250614","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1097\/00005131-200402000-00002","article-title":"Correlation of interosseous membrane tears to the level of the fibular fracture","volume":"18","author":"Nielson","year":"2004","journal-title":"J Orthop Trauma."},{"key":"R17-20250614","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/01.blo.0000161090.86162.19","article-title":"Radiographic measurements do not predict syndesmotic injury in ankle fractures: an MRI study","author":"Nielson","year":"2005","journal-title":"Clin Orthop Relat Res."}],"container-title":["Journal of Orthopaedic 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