CASE REPORT article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1658026
This article is part of the Research TopicAdvancing Musculoskeletal Health: Bridging Basic and Clinical Research on Biomechanical Properties of Joints, Ligaments, Tendons, and Associated StructuresView all 7 articles
Supination Adduction Stage 2 Associated with Transverse Fracture of the Lateral Malleolus and Rupture of the Anterior Talofibular Ligament: A Case Report and Literature Review
Provisionally accepted
Jingxuan 王敬轩 Wang1,2
Kangyong 杨康勇 Yang2
Zhen-Jiang Liu3Ke 揭珂 Jie2Biqing 黄碧清 Huang1,2
Shiheng Wang1,2Zhihong 莫智鸿 Mo1,2Yunxuan 邹运璇 Zou2*- 1Guangzhou University of Chinese Medicine, Guangzhou, China
- 2Foshan Hospital of Traditional Chinese Medicine, Foshan, China
- 3China Academy of Chinese Medical Sciences Wangjing Hospital, Beijing, China
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Abstract Background: Supination-adduction (SAD) type ankle fractures occur when the ankle is subjected to inversion forces while in a supinated position, leading to transverse fractures of the lateral malleolus or lateral ligament injuries, often accompanied by vertical fractures of the medial malleolus. The simultaneous occurrence of a transverse lateral malleolus fracture and a rupture of the anterior talofibular ligament is uncommon.Unlike the typical SAD pattern, the concurrent occurrence of a transverse lateral malleolus fracture combined with rupture of the Anterior Talofibular Ligament (ATFL) is uncommon and has not been reported in the literature; Due to limited case reports, thesesuch injuries are frequently missed in clinical practice, which in turn affects clinicians' treatment decisions and the recovery of ankle joint stability and function. Case Presentation: This report describes a case of an adult Asian female patient who sustained a left ankle injury due to a missed step, resulting in swelling and pain. The initial diagnosis was a left double ankle fracture (supination-adduction stage2 SAD stage 2). During surgery, after stabilizing the medial and lateral malleoli, fluoroscopy revealed that the talus could not be reduced. An extended incision identified the anterior talofibular ligamentATFL rupture, which was subsequently repaired using the Broström-Gould technique. Post-repair fluoroscopy confirmed satisfactory reduction of the talus and proper alignment of the ankle joint. After two weeks of cast immobilization, the patient began gradual rehabilitation exercises. At the 18-month follow-up, the patient exhibited good ankle function, achieving an American Orthopaedic Foot and Ankle Society Ankle - Hindfoot Scale of 100. Conclusion: This report shares the clinical experience in diagnosing and treating occult injuries of the ATFL in a case of supination-adduction stage2SAD stage 2 ankle fracture to enhance awareness and prevent missed diagnoses in similar injuries. We emphasize that in SAD stage 2 fractures showing unexplained talar tilt after fixation, clinicians should suspect and evaluate for occult ATFL injury to avoid missed diagnoses and optimize treatment decisions.
Keywords: Ankle fracture, Lauge-Hansen classification, supination-adduction, Anterior talofibular ligament rupture, Failure point, case reports
Received: 02 Jul 2025; Accepted: 08 Sep 2025.
Copyright: © 2025 Wang, Yang, Liu, Jie, Huang, Wang, Mo and Zou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yunxuan 邹运璇 Zou, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
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