Background: The 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. Objective: The 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. Method: Retrospective 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. Results: In 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). Conclusion: Detection 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.

Ankle, Avulsion fractures, Foot, Sprain, Supination line,
Surgery and Traumatology
The Foot
Erasmus MC: University Medical Center Rotterdam

Schepers, T, van Schie- van der Weert, E.M, de Vries, M.R, & van der Elst, M. (2011). Foot and ankle fractures at the supination line. The Foot, 21(3), 124–128. doi:10.1016/j.foot.2010.11.008