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VOLUME 7 , ISSUE 2 ( August, 2012 ) > List of Articles


The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review

Sjoerd A. S. Stufkens, Michel P. J. van den Bekerom, Markus Knupp, Beat Hintermann, C. Niek van Dijk

Keywords : Ankle fracture, Deltoid ligament, Stability, Diagnosis, Treatment

Citation Information : Stufkens SA, van den Bekerom MP, Knupp M, Hintermann B, van Dijk CN. The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review. 2012; 7 (2):73-85.

DOI: 10.1007/s11751-012-0140-9

License: CC BY-NC-SA 4.0

Published Online: 31-08-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


The supination–external rotation or Weber B type fracture exists as a stable and an unstable type. The unstable type has a medial malleolus fracture or deltoid ligament lesion in addition to a fibular fracture. The consensus is the unstable type and best treated by open reduction and internal fixation. The diagnostic process for a medial ligament lesion has been well investigated but there is no consensus as to the best method of assessment. The number of deltoid ruptures as a result of an external rotation mechanism is higher than previously believed. The derivation of the injury mechanism could provide information of the likely ligamentous lesion in several fracture patterns. The use of the Lauge-Hansen classification system in the assessment of the initial X-ray images can be helpful in predicting the involvement of the deltoid ligament but the reliability in terms of sensitivity and specificity is unknown. Clinical examination, stress radiography, magnetic resonance imaging, arthroscopy, and ultrasonography have been used to investigate medial collateral integrity in cases of ankle fractures. None of these has shown to possess the combination of being cost-effective, reliable and easy to use; currently gravity stress radiography is favoured and, in cases of doubt, arthroscopy could be of value. There is a disagreement as to the benefit of repair by suture of the deltoid ligament in cases of an acute rupture in combination with a lateral malleolar fracture. There is no evidence found for suturing but exploration is thought to be beneficial in case of interposition of medial structures.

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  1. Anderson LD (1971) Fractures. In: Crenshaw AH (ed) Campbell's operative orthopaedics, 5th edn. Mosby, St. Louis, p 556
  2. Arimoto HK, Forrester DM (1980) Classification of ankle fractures: an algorithm. Am J Roentgenol 135:1057-1063
  3. Baird RA, Jackson ST (1987) Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament. J Bone Jt Surg Am 69(9):1346-1352
  4. Bauer M, Bergström B, Hemborg A, Sandega°rd J (1985) Malleolar fractures: nonoperative versus operative treatment. A controlled study. Clin Orthop Relat Res 199:17-27
  5. Bauer M, Johnell O, Redlund-Johnell I, Johnsson K (1987) Ankle fractures. Foot Ankle 8:23-25
  6. Bauer M, Johnson K, Nilsson B et al (1985) Thirty-year followup of ankle fractures. Acta Orthop Scand 56:103-106
  7. Baumhauer JF, Geppert MJ, Michelson JD et al (2002) Ankle and foot: trauma. In: Koval K (ed) Orthopaedic knowledge update, vol 7. American Academy of Orthopaedic Surgeons, Rosemont, p 548
  8. Bekerom van den MPJ, Mutsaerts ELAR, Dijk van CN (2009) Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature. Arch Orthop Trauma Surg 129(2):227-235
  9. Beris AE, Kabbani KT, Xenakis TA, Mitsionis G, Soucacos PK, Soucacos PN (1997) Surgical treatment of malleolar fractures. Clin Orthop Rel Res 341:90-98
  10. Bonnin JG (1950) Injuries to the ankle. William Heinemann Medical Books Ltd, London
  11. Bonnin JG (1965) Injury to the ligaments of the ankle. J Bone Jt Surg Br 47-B:609-611
  12. Boone DC, Azen SP, Chun-Mei L, Spence C, Baron C, Lee L (1979) Normal range of motion in male subjects. J Bone Jt Surg Am 61-A:756-759
  13. Boss AP, Hintermann B (2002) Anatomical study of the medial ankle ligament complex. Foot Ankle Int 23:547-553
  14. Brasseur JL, Luzzati A, Lazennec JY et al (1994) Ultrasonography of the ankle ligaments. Surg Radiol Anat 16:87
  15. Braunstein PW, Wade PA (1959) Treatment of unstable fractures of the ankle. Ann Surg 149:217-226
  16. Brink O, Staunstrup H, Sommer J et al (1996) Stable lateral malleolar fractures treated with air cast ankle brace and Donjoy R.O.M.-Walker brace: a prospective randomized study. Foot Ankle Int 17:679-684
  17. Burwell HN, Charnley AD (1965) The Treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Jt Surg Br 47-B:634-660
  18. Campbell DG, Menz A, Isaacs J (1994) Dynamic ankle ultrasonography. A new imaging technique for acute ankle ligament injuries. Am J Sports Med 22(6):855-858
  19. Carr JB, Trafton P (1998) Malleolar and soft tissue injuries of the ankle. In: Browner B, Jupiter J et al (eds) Skeletal trauma. Saunders, Philadelphia, p 2357
  20. Cedell CA (1974) Rupture of the posterior talotibial ligament with the avulsion of a bone fragment from the talus. Acta Orthop Scand 45:454-461
  21. Clarke HJ, Michelson JD, Cox QG, Jinnah RH (1991) Tibiotalar stability in bimalleolar ankle fractures: a dynamic in vitro contact area study. Foot Ankle 11:222-227
  22. Close JR (1956) Some applications of the functional anatomy of the ankle joint. J Bone Jt Surg Am 38:761-781
  23. Court-Brown CM, McBirnie J, Wilson G (1998) Adult ankle fractures—an increasing problem?Acta Orthop Scand 69(1):43-47
  24. Daly PJ, Fitzgerald RH Jr, Melton LJ, Ilstrup DM (1987) Epidemiology of ankle fractures in Rochester, Minnesota. Acta Orthop Scand 58(5):539-544
  25. DeAngelis JP, Anderson R, DeAngelis NA (2007) Understanding the superior clear space in the adult ankle. Foot Ankle Int 28(4):490-493
  26. DeAngelis NA, Eskander MS, French BG (2007) Does medial tenderness predict deep deltoid ligament incompetence in supination- external rotation type ankle fractures? J Orthop Trauma 21:244-247
  27. Dehne E (1934) Die Klinik der frischen und habituellen Adduktionssupinations-distorsion des Fusses. Deutsch Zschr 242:40-61
  28. Denham RA (1964) Internal fixation for unstable ankle fractures. J Bone Jt Surg Br 46-B:206-211
  29. deSouza LJ, Gustilo RB, Meyer TJ (1985) Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J Bone Jt Surg Am 67-A:1066-1074
  30. Dias LS (1979) The lateral ankle sprain: an experimental study. J Trauma 19:266-269
  31. van Dijk CN, Bossuyt PM, Marti RK (1996) Medial ankle pain after lateral ligament rupture. J Bone Jt Surg Br 78(4):562-567
  32. van Dijk CN, Mol BW, Lim LS, Marti RK, Bossuyt PM (1996) Diagnosis of ligament rupture of the ankle joint. Physical examination, arthrography, stress radiography and sonography compared in 160 patients after inversion trauma. Acta Orthop Scand 67(6):566-570
  33. van Dijk CN, Verhagen RA, Tol JL (1997) Arthroscopy for problems after ankle fracture. J Bone Jt Surg Br 79(2):280-284
  34. Dziob JM (1956) Ligamentous injuries about the ankle joint. Am J Surg 91:692-698
  35. Ebraheim NA, Elgafy H, Padanilam T (2003) Syndesmotic disruption in lower fibular fractures associated with deltoid ligament injury. Clin Orthop Relat Res 409:260-267
  36. Egol KA, Amirtharajah M, Tejwani NC, Capla EL, Koval KJ (2004) Ankle stress test for predicting the need for surgical fixation of isolated fibular fractures. J Bone Jt Surg Am 86(11):2393-2398
  37. von Friedrich JM, Heuchemer T, Schimacher KA et al (1990) Ultrasound in the diagnosis of fresh talofibular ligamentous lesions [in German]. Rofo Fortschr Geb Roentgenstr Neuen Bildgeb Verfahr 152:173
  38. von Friedrich JM, Schnorkowski P, Rubenacker S et al (1993) Ultrasonography of capsular morphology in normal and traumatic ankle joints. J Clin Ultrasound 21:179
  39. Fürmaier A (1951) Zur Diagnose und Therapie der Bandverletzungen und Gabelsprengungen am oberen Sprunggelenk. Arch Orthop Unfall Chir 44:541-552
  40. Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG (2006) The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures: an MRI study. J Orthop Trauma 20(4):267-272
  41. Gill JB, Risko T, Raducan V, Speight Grimes J, Schutt C Jr (2007) Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures. J Bone Jt Surg Am 89(5):994-999
  42. Grath G (1960) Widening of the ankle mortise. A clinical and experimental study. Acta Orthop Scand 263:1-88
  43. Gruber G, Nebe M, Bachman G et al (1998) Ultrasonography as a diagnostic measure in the rupture of fibular ligaments. Comparative study: sonography versus radiological investigations. Rofo Fortschr Geb Roentgenstr Neuen Bildgeb Verfahr 169:152
  44. Harper MC (1987) Deltoid ligament: an anatomic evaluation of function. Foot Ankle 8:19-22
  45. Harper MC (1988) The deltoid ligament. An evaluation of need for surgical repair. Clin Orthop Relat Res 226:156-168
  46. Harper MC (1995) The short oblique fracture of the distal fibula without medial injury: an assessment of displacement. Foot Ankle Int 16:181-185
  47. Hartford JM, Gorczyca JT, McNamara JL, Mayor MB (1995) Tibiotalar contact area: contribution of posterior malleolus and deltoid ligament. Clin Orthop Relat Res 320:182-187
  48. Heck CV, Hendryson IE, Rowe CR (eds) (1965) Joint motion— method of measuring and recording: American academy of orthopaedic surgeons. Churchill Livingstone, Edinburgh
  49. Hintermann B, Regazzoni P, Lampert C, Stutz G, Gachter A (2000) Arthroscopic findings in acute fractures of the ankle. J Bone Jt Surg Br 82:345-351
  50. Hintermann B, Sommer C, Nigg BM (1995) Influence of ligament transection on tibial and calcaneal rotation with loading and dorsi-plantarflexion. Foot Ankle Int 16(9):567-571
  51. Hintermann B (1999) Biomechanics of the unstable ankle joint and clinical implications. Med Sci Sports Exerc 31:459-469
  52. Hintermann B (2005) What the orthopaedic foot and ankle surgeon wants to know from MR imaging. Sem Musc Radiol 9(3):260-271
  53. Hönigschmied J (1877) Leichenexperimente über die Zerreissungen der Bänder im Sprunggelenk mit Rücksicht auf die Entstehung der indirecten Knöchelfracturen. Deutsch Zschr Chir 8:239-260
  54. Jackson R, Wills RE, Jackson R (1988) Rupture of deltoid ligament without involvement of the lateral ligament. Am J Sports Med 16:541-543
  55. Jensen SL, Andresen BK, Mencke S, Nielsen PT (1998) Epidemiology of ankle fractures. A prospective population-based study of 212 cases in Aalborg, Denmark. Acta Orthop Scand 69(1):48-50
  56. Johnson EE, Markolf KL, Sakai DN, Dunn JP (1981) Contribution of the anterior talo-fibular ligament to ankle stability. J Bone Jt Surg 5:214-215
  57. Joy G, Patzakis MJ, Harvey JP Jr (1974) Precise evaluation of the reduction of severe ankle fractures. J Bone Jt Surg 56:979-993
  58. Klein MA (1994) MR imaging of the ankle: normal and abnormal findings in the medial collateral ligament. Am J Roentgenol 162(2):377-383
  59. Klossner O (1962) Late results of operative and non-operative treatment of severe ankle fractures. Acta Chir Scand 35(Suppl 293):1-93
  60. Koval KJ, Egol KA, Cheung Y, Goodwin DW, Spratt KF (2007) Does a positive ankle stress test indicate the need for operative treatment after lateral malleolus fracture? A preliminary report. J Orthop Trauma 21(7):449-455
  61. Kristensen KD, Hansen T (1985) Closed treatment of ankle fractures. Stage II supination-eversion fractures followed for 20 years. Acta Orthop Scand 56(2):107-109
  62. Larsen E (1976) The unstable ankle joint. Clinical and radiological assessment with particular attention to the significance of the “drawer symptom”. Ugeskr Laeger 138(33):1989-1993 [article in Danish]
  63. Lauge-Hansen N (1949) “Ligamentous” ankle fractures. Diagnosis and treatment. Acta Chir Scand 97:544
  64. Lauge-Hansen N (1950) Fractures of the ankle II: combined experimental-surgical and experimental-roengenologic investigations. Arch Surg 60:957-985
  65. Laurin CA, Mathieu J (1975) Sagittal mobility of the normal ankle. Clin Orthop 108:99-104
  66. Laurin CA, Quellet R, St-Jacques R (1968) Talar and subtalar tilt: an experimental investigation. Can J Surg 11:270-279
  67. Leith JM, McConkey JP, Li D, Masri B (1997) Valgus stress radiography in normal ankles. Foot Ankle Int 18(10):654-657
  68. Lindsjö U (1985) Classification of ankle fractures: the Lauge- Hansen or AO system? Clin Orthop Relat Res 1999:12-16
  69. Lindsjö U (1985) Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res 199:28-38
  70. Lindsjö U (1981) Operative treatment of ankle fractures. Acta Orthop Scand 189(52):1-131
  71. Loren GJ, Ferkel RD (2002) Arthroscopic assessment of occult intra-articular injury in acute ankle fractures. Arthroscopy 18(4):412-421
  72. Maissonneuve MJG (1840) Recherches sur la fracture du péroné. Arch Gen Med 52:165-187
  73. Makwana NK, Bhowal B, Harper WM, Hui AW (2001) Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomized study. J Bone Jt Surg Br 83:525-529
  74. Malka J, Taillard W (1969) Results of non-operative and operative treatment of fractures of the ankle. Clin Orthop Relat Res 67:159-168
  75. Marsh JL, Salzman CL (2001) Ankle fractures. In: Bucholz R, Heckman JD (eds) Fractures in adults. Lippincott, Philadelphia, p 2003
  76. Mast JW, Teipner WA (1980) A reproducible approach to the internal fixation of adult ankle fractures: rationale, technique and early results. Orthop Clin N Am 11:661-679
  77. Maynou C, Lesage P, Mestdagh H, Butruille Y (1997) Is surgical treatment of deltoid ligament rupture necessary in ankle fractures? Rev Chir Orthop Repar Appar Mot 83(7):652-657
  78. McConnell T, Creevy W, Tornetta P III (2004) Stress examination of supination external rotation-type fibular fractures. J Bone Jt Surg 86-A(10):2171-2178
  79. McCullough CJ, Burge PD (1980) Rotatory instability of the load-bearing ankle. J Bone Jt Surg Br 62-B:460-464
  80. McDade WC (1975) Treatment of ankle fractures. In: Buckwalter JA (ed) Instructional course lectures, the American Academy of Orthopaedic Surgeons, vol 24. Mosby, St. Louis, pp 251-293
  81. McLaughlin HL (1959) Injuries of the ankle. In: Herman JL (ed) Trauma. Saunders, Philadelphia, pp 333-362
  82. Mengiardi B, Pfirrmann CWA, Vienne P, Hodler J, Zanetti M (2007) Medial collateral ligament complex of the ankle: MR appearance in asymptomatic subjects. Radiology 242(3):817-824
  83. Michelson JD, Ahn UM, Helgemo SL (1996) Motion of the ankle in a simulated supination-external rotation fracture model. J Bone Jt Surg 78:1024-1031
  84. Michelson JD, Magid D, Ney DR, Fishman EK (1992) Examination of the pathologic anatomy of ankle fractures. J Trauma 32(1):65-70
  85. Michelson JD, Solocoff D, Waldman B, Kendell K, Ahn U (1997) Ankle fractures. The Lauge-Hansen classification revisited. Clin Orthop Relat Res 345:198-205
  86. Michelson JD, Varner KE, Checcone M (2001) Diagnosing deltoid injury in ankle fractures: the gravity stress view. Clin Orthop Relat Res 387:178-182
  87. Michelson JD (1995) Fractures about the ankle. J Bone Jt Surg 77:142-152
  88. Milner CE, Soames RW (1998) The medial collateral ligaments of the human ankle joint: anatomical variations. Foot Ankle Int 19:289-292
  89. Milz P, Milz S, Putz R et al (1996) 13 MgHz highfrequency sonography of the lateral ankle joint ligaments and the tibiofibular syndesmosis in anatomic specimens. J Ultrasound Med 15:277
  90. Milz P, Milz S, Steinborn M et al (1999) 13 MgHz high frequency ultrasound of the lateral ligaments of the ankle joint and the anterior tibio-fibular ligament. Comparison and results of MRI in 64 patients. Radiologe 39:34
  91. Morvan G, Busson J, Wybier M, Mathieu P (2001) Ultrasound of the ankle. Eur J Ultrasound 14:73-82
  92. Nielsen JO, Dons-Jensen H, Sorensonn HT (1990) Lauge-Hansen classification of malleolar fractures. An assessment of the reproducibility in 118 cases. Acta Orthop Scand 61:385-387
  93. Padovani JP (1975) Rappel anatomique et physiologique des ligaments latéraux de l'articulation tibio-tarsienne et des ligaments péronéo-tibiaux inférieurs. Rev Chir Orthop 61:124-127
  94. Pai VS (1999) Medial malleolar fracture associated with deltoid ligament rupture. J Foot Ankle Surg 38(6):420-422
  95. Pankovich AM (1979) Fractures of the fibula at the distal tibiofibular syndesmosis. Clin Orthop 143:138-147
  96. Pankovich AM (1976) Maisonneuve fracture of the fibula. J Bone Jt Surg Am 58-A:337-342
  97. Pankovich AM, Shivaram MS (1979) Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament. I. Anatomical studies. Acta Orthop Scand 50:217-223
  98. Pankovich AM, Shivaram MS (1979) Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament. II. Clinical studies. Acta Orthop Scand 50:225-236
  99. Park SS, Kubiak EN, Egol KA, Kummer F, Koval KJ (2006) Stress radiographs after ankle fracture: the effect of ankle position and deltoid ligament status on medial clear space measurements. J Orthop Trauma 20:11-18
  100. Peetrons P, Creteur V, Bacq C (2004) Sonography of ankle ligaments. J Clin Ultrasound 32:491-499
  101. Pettrone FA, Gail M, Pee D, Fitzpatrick T, Van Herpe LB (1983) Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Jt Surg 65A:667-677
  102. Phillips WA, Schwartz HS, Keller CS, Woodward HR, Rudd WS, Spiegel PG, Laros GS (1985) A prospective, randomized study of the management of severe ankle fractures. J Bone Jt Surg 67:67-78
  103. Ponzer S, Nasell H, Bergman B, Tornkvist H (1999) Functional outcome and quality of life in patients with type B ankle fractures: a two-year follow-up study. J Orthop Trauma 13(5):363-368
  104. Port A, McVie J, Naylor G et al (1996) Comparison of two conservative methods of treating an isolated fracture of the lateral malleolus. J Bone Jt Surg 78B:568-572
  105. Purvis GD (1973) The unstable oblique distal fibular fracture. Clin Orthop 92:330-337
  106. Quigley TB (1959) Fractures and ligament injuries of the ankle. Am J Surg 98:477-483
  107. Rasmussen O, Tovborg-Jensen I, Boe S (1982) Distal talofibular ligaments: analysis of function. Acta Orthop Scand 53:681
  108. Rasmussen O (1985) Stabillity of the ankle joint: analysis of the function and traumatology of the ankle ligaments. Acta Orthop Scand 56:1-75
  109. Rasmussen OS (2000) Sonography of tendons. Scand J Med Sci Sports 10:360-364
  110. Rasmussen S, Madsen PV, Bennicke K (1993) Observer variation in the Lauge-Hansen classification of ankle fractures. Precision improved by instruction. Acta Orthop Scand 64:693-694
  111. Richter J, Schulze W, Clasbrummel B, Muhr G (2003) Beitrag der Syndesmosen und des Deltabandes zur Stabilität der Aussenknöchelfraktur Typ Weber B. Eine Experimentelle Untersuchung Unfallchirurg 106:359-366
  112. Rubin G, Witten M (1960) The talar-tilt angle and the fibular collateral ligaments. J Bone Jt Surg Am 42:311-326
  113. Ryan JR (1981) Fracture of the lateral malleolus with associated tear of the medial collateral ligament of the ankle. Ann Emerg Med 20:211-212
  114. Sasse M, Nigg BM, Stefanyshyn DJ (1999) Tibiotalar motion— effect of fibular displacement and deltoid ligament transaction: in vitro study. Foot Ankle Int 20(11):733-737
  115. Schnarkowski P, Glucker TM, Friedrich JM et al (1992) Sonographic findings in lateral ligament lesions of the upper ankle joint following conservative and operative therapy. Rofo Fortschr Geb Roentgenstr Neuen Bildgeb Verfahr 157:561
  116. Schneck CD, Mesgarzadeh M, Bonakdarpour A, Ross GJ (1992) MR imaging of the most commonly injured ankle ligaments. Part I. Normal anatomy. Radiology 184(2):499-506
  117. Schuberth JM, Collman DR, Rush SM, Ford LA (2004) Deltoid ligament integrity in lateral malleolar fractures: a comparative analysis of arthroscopic and radiographic assessments. J Foot Ankle Surg 43(1):20-29
  118. Sheth DS, Ambrose CG (2005) Stress test for predicting the need for surgical fixation of fibular fractures. J Bone Jt Surg 87(5):1165; author reply 1165
  119. Siegler S, Block J, Schneck CD (1988) The mechanical characteristics of the collateral ligaments of the human ankle joint. Foot Ankle 8(5):234-242
  120. Solonen KA, Lauttamus L (1968) Operative treatment of ankle fractures. Acta Orthop Scand 39:223-237
  121. Staples OS (1960) Injuries to the medial ligaments of the ankle. J Bone Jt Surg Am 42A:1287-1307
  122. Strömsöe K, Höqevold HE, Skjeldal S, Alho A (1995) The repair of a ruptured deltoid ligament is not necessary in ankle fractures. J Bone Jt Surg Br 77(6):920-921
  123. Tejwani NC, McLaurin TM, Walsh M, Bhadsavle S, Koval KJ, Egol KA (2007) Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury? J Bone Jt Surg Am 89:1438-1441
  124. Thomsen NOB, Overgaard S, Olsen LH, Hansen H, Nielsen ST (1991) Observer variation in the radiographic classification of ankle fractures. J Bone Jt Surg 73B:676-678
  125. Tornetta P III (2000) Competence of the deltoid ligament in bimalleolar ankle fractures after medial malleolar fixation. J Bone Jt Surg 82(6):843-848
  126. Tourne Y, Charbel A, Picard F, Montbarbon E, Saragaglia D (1999) Surgical treatment of bi- and tri-malleolar ankle fractures: should the medial collateral ligament be sutured or not? J Foot Ankle Surg 38(1):24-29
  127. Weber BG (1979) Injuries of the ankle, 2nd edn. Verlag Hans Huber, Bern
  128. Weber M, Burmeister H, Flueckiger G, Krause FG (2010) The use of weightbearing radiographs to assess the stability of supination-external rotation fractures of the ankle. Arch Orthop Trauma Surg 130(5):693-698
  129. Wilson FC (1984) Fractures and dislocations of the ankle. In: Rockwood CA, Green DP (eds) Fractures in adults, vol 2, 2nd edn. Lippincott, Philadelphia, p 1691
  130. Yablon IG, Heller FG, Shouse L (1976) The key role of the lateral malleolus in the displaced fracture of the ankle. J Bone Jt Surg Am 59-A:169-173
  131. Yde J, Kristensen KD (1980) Ankle fractures: supination-eversion fractures of stage IV. Primary and late results of operative and non-operative treatment. Acta Orthop Scand 51:981-990
  132. Yde J (1980) The Lauge-Hansen classification of malleolar fractures. Acta Orthop Scand 51:181-192
  133. Zeegers AV, van der Werken C (1989) Rupture of the deltoid ligament in ankle fractures: should it be repaired? Injury 20(1):39-41
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