Foot and ankle fractures at the supination line

BackgroundThe supination line is a fictive line along the foot and ankle, on which over twenty fracture types and approximately ten different ligamentous sprain-injuries have been identified.ObjectiveThe current study was conducted to evaluate the incidence of different types of supination line injuries visible at the initial radiographs at the Emergency Department and to determine the type and percentage of misdiagnosed injuries.MethodRetrospective study of consecutive patients who visited the Emergency Department, between January 1 and June 30, 2009, after sustaining an injury of the foot or ankle and had a radiograph taken within 24 h of the incident.ResultsIn the 6-month study period 1284 patients were included. In these cases the trauma mechanism was a sprain in 780 patients (60.7%). Of these patients 310 suffered from a fracture (40%). There were 36 (4.6%) false-positive cases and in 91 (11.7%) cases the initial diagnosis was false-negative. The number with a missed fracture expressed as a percentage of all patients with a fracture was 29.4% (91/310).ConclusionDetection of injuries along the supination line remains difficult. This study might aid in decreasing the number of misdiagnosed injuries, which is of value as these might negatively affect outcome.