{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T02:28:36Z","timestamp":1789266516830,"version":"build-2803163510"},"reference-count":30,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100018402","name":"Swiss Orthopaedics","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100018402","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Previous biomechanical studies simulating supination\u2013external rotation (SER) IV injuries revealed different alterations in contact area and peak pressure. We investigated joint reaction forces and radiographic parameters in an unrestrained, more physiological setup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twelve lower leg specimens were destabilized stepwise by osteotomy of the fibula (SER II) and transection of the superficial (SER IVa) and the deep deltoid ligament (SER IVb) according to the Lauge-Hansen classification. Sensors in the ankle joint recorded tibio-talar pressure changes with axial loading at 700 N in neutral position, 10\u00b0 of dorsiflexion, and 20\u00b0 of plantarflexion. Radiographs were taken for each step.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Three of 12 specimen collapsed during SER IVb. In the neutral position, the peak pressure and contact area changed insignificantly from 2.6 \u00b1 0.5 mPa (baseline) to 3.0 \u00b1 1.4 mPa (SER IVb) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .35) and from 810 \u00b1 42 mm\n                      <jats:sup>2<\/jats:sup>\n                      to 735 \u00b1 27 mm\n                      <jats:sup>2<\/jats:sup>\n                      (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .08), respectively. The corresponding medial clear space (MCS) increased significantly from 2.5 \u00b1 0.4 mm (baseline) to 3.9 \u00b1 1.1 mm (SER IVb) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .028).\n                    <\/jats:p>\n                    <jats:p>\n                      The position of the ankle joint had a decisive effect on contact area (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .00), center of force (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .00) and MCS (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Simulated SER IVb injuries demonstrated radiological, but no biomechanical changes. This should be considered for surgical decision making based on MCS width on weightbearing radiographs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Levels of Evidence:<\/jats:title>\n                    <jats:p>Not applicable. Biomechanical study<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1938640020950183","type":"journal-article","created":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T05:13:28Z","timestamp":1599023608000},"page":"330-337","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Ankle Joint Pressure in Supination\u2013External Rotation Injuries: A Biomechanical Study in an Unrestrained Cadaver Model"],"prefix":"10.1177","volume":"15","author":[{"given":"Andreas C.","family":"F\u00f6sel","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK)"},{"name":"AO-Research Institute Davos, Switzerland (IZ, BG)"},{"name":"Department of Orthopaedic Surgery and Traumatology, B\u00fcrgerspital Solothurn, Solothurn, Switzerland (ACF)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7759-2011","authenticated-orcid":false,"given":"Angela","family":"Seidel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK)"},{"name":"AO-Research Institute Davos, Switzerland (IZ, BG)"},{"name":"Department of Orthopaedic Surgery and Traumatology, B\u00fcrgerspital Solothurn, Solothurn, Switzerland (ACF)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc C.","family":"Attinger","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK)"},{"name":"AO-Research Institute Davos, Switzerland (IZ, BG)"},{"name":"Department of Orthopaedic Surgery and Traumatology, B\u00fcrgerspital Solothurn, Solothurn, Switzerland (ACF)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Zderic","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK)"},{"name":"AO-Research Institute Davos, Switzerland (IZ, BG)"},{"name":"Department of Orthopaedic Surgery and Traumatology, B\u00fcrgerspital Solothurn, Solothurn, Switzerland (ACF)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK)"},{"name":"AO-Research Institute Davos, Switzerland (IZ, BG)"},{"name":"Department of Orthopaedic Surgery and Traumatology, B\u00fcrgerspital Solothurn, Solothurn, Switzerland (ACF)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian G.","family":"Krause","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK)"},{"name":"AO-Research Institute Davos, Switzerland (IZ, BG)"},{"name":"Department of Orthopaedic Surgery and Traumatology, B\u00fcrgerspital Solothurn, Solothurn, Switzerland (ACF)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2006.04.130"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1950.01250010980011"},{"key":"e_1_3_2_4_2","first-page":"79","article-title":"The pathogenesis and treatment of ankle fractures: classification","volume":"39","author":"Wilson FC.","year":"1990","unstructured":"Wilson FC. 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The effects of fibular and talar displacement on joint contact areas about the ankle. 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