Clin Orthop Surg.  2015 Mar;7(1):15-21. 10.4055/cios.2015.7.1.15.

Paratrooper's Ankle Fracture: Posterior Malleolar Fracture

• Young KW
• Kim JS
• Cho JH
• Kim HS
• Cho HK
• Lee KT

• KMID: 2069870
• DOI: http://doi.org/10.4055/cios.2015.7.1.15

Abstract

BACKGROUND
We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes.
METHODS
Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity.
RESULTS
The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome.
CONCLUSIONS
Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to undergo surgical repairs.

Keyword

Ankle injury; Fracture; Parachuting

MeSH Terms

Adult
Ankle Fractures/classification/etiology/radiography/*surgery
Ankle Injuries/etiology/radiography/*therapy
Ankle Joint/radiography/*surgery
Aviation
Bone Plates
Fracture Fixation, Internal
Fractures, Comminuted/etiology/radiography/surgery
Fractures, Open/etiology/radiography/surgery
Humans
Male
Military Personnel
Retrospective Studies
Young Adult

Figure

• 

  Fig. 1 Weber classification. (A) Type A: fracture of the fibula is located below the syndesmosis. (B) Type B: fracture of the fibula is at the level of the tibiofibular syndesmosis. (C) Type C: fracture of the fibula is proximal to the syndesmosis. Syndesmosis is ruptured up to the point of fracture.

• 

  Fig. 2 The ankle fractures were identified by the position of the fracture fragments: medial (A), lateral (B), and posterior malleolar fractures (C); simple (A, B) and complex fractures (C); and deltoid rupture and syndesmotic diastasis.

• 

  Fig. 3 Mechanism of posterior malleolar fracture. (A) Combination of axial load plus the plantar flexion position of the foot at the time of impact. (B) Combination of axial loading plus a supinated foot or external rotation of the talus. By virtue of the obliquity of the axis about which subtalar movement occurs, inversion, external rotation of the talus occurs. First, the fibula fails, producing an oblique fracture. (C) Progressive talar external rotation causes posterior malleolar fractures.

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