The Role of Axial Loading in Malleolar Fractures

Though rotation is thought to be the most common mechanism of foot and ankle injury in both automobile crashes and in everyday life, axial impact loading is considered responsible for most severe lower extremity injuries. In this study, dynamic axial impact tests were conducted on 92 isolated human lower limbs. The test apparatus delivered the impact via a pendulum-driven plate which intruded longitudinally to simulate the motion of the toepan in an automobile crash. Magneto-hydrodynamic (MHD) angular rate sensors fixed to the limbs measured ankle rotations during the impact event. Malleolar or fibula fractures, which are commonly considered to be caused by excessive ankle rotation, were present in 38% (12 out of 32) of the injured specimens. Ankle rotations in these tests were always within 10° of neutral at the time of peak axial load and seldom exceeded failure boundaries reported in the literature at any point during the impact event. These results suggest that high-energy axial loading may be the cause of some of the injuries conventionally thought to be caused by excessive rotations in real-world car crashes.