Predicting poor outcome from simple ankle injuries: a prospective cohort study

Bullock, Stuart; Allen, Georgina; Watson, Marion; Wilson, David J.

doi:10.1259/bjr.20170213

Cited by 5 publications

(2 citation statements)

References 19 publications

(25 reference statements)

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“…It appeared that there was no clinically significant difference in functional outcome based on the types of injury that patients underwent but it was presented that there are factors to consider early in the recovery after an injury to optimise a return to normal function. 10 This study has shown a similar result to a paper comparing ankle ligament injuries detected by ultrasound as compared to MRI. 19 Ultrasound has also been clearly shown to demonstrate soft tissue injuries of the ankle well, although, there is some attention to detail required to identify the ankle ligaments correctly.…”

Section: Bjr Allen Et Alsupporting

confidence: 83%

“…The functional outcome of the patients from this study measured at 3 and 6 months, and the associations with ligament injury patterns has already been presented. 10 Therefore, the objectives of this paper are to describe the study in total but to focus on examining the occult fracture incidence and associations, and to also consider the appropriateness of examination methods for acute ankle injuries.…”

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confidence: 99%

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Extremity CT and ultrasound in the assessment of ankle injuries: occult fractures and ligament injuries

Allen

Wilson

Bullock³

et al. 2019

The British Journal of Radiology

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Objective: To assess the rates of fractures and ligament injuries in patients with an acute ankle injury and a normal radiographic examination, and to consider the most appropriate examination protocol. Methods: Patients with an acute ankle injury who presented to the John Radcliffe Hospital Emergency Department with a normal radiographic examination were eligible for the study. They were invited to receive a cone beam CT and ultrasound examination at a local radiology department within 5 days of their ankle injury. Results: Of the 100 patients recruited to the study, 19 patients were found to have major fractures and 42 patients had small avulsion fractures. Additionally, 42 patients had ankle effusions and there were a large number of soft tissue injuries. There were 83 acute injuries of the anterior talofibular ligament, 19 of the anterior tibiofibular ligaments, 26 of the calcaneofibular ligament, 39 of the deltoid ligament complex, 21 of the talonavicular ligament, 14 of the spring ligament and 3 of the calcaneocuboid ligament. Conclusion: Conventional radiographic examination misses significant fractures of the foot and ankle and the presence of an ankle effusion does not relate to the severity of injury. Ultrasound is a useful imaging technique that can supplement clinical practice, but it is unlikely to replace current protocols alone. Cone beam CT is an appropriate alternative to plain radiography, being more sensitive in detecting fractures and delivering a similar dose of radiation. However, neither CT or ultrasound examination can detect all avulsion fractures. Simple anterior process fractures of the calcaneus are associated with talonavicular ligament injuries and the medial ligaments are injured in almost 50% of cases when there is a lateral ligament injury. Advances in knowledge: Fractures in the foot and ankle are detected more precisely with cone beam CT compared to radiographs. Cone beam CT delivers similar doses of to conventional radiographs which is around 10% of that resulting from conventional CT. Ultrasound examination is an effective assessment tool to detect ligamentous injuries. The absence of an ankle effusion does not exclude a major fracture.

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Section: Bjr Allen Et Alsupporting

confidence: 83%

mentioning

confidence: 99%

Extremity CT and ultrasound in the assessment of ankle injuries: occult fractures and ligament injuries

Allen

Wilson

Bullock³

et al. 2019

The British Journal of Radiology

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Diagnostic accuracy of clinical tests assessing ligamentous injury of the ankle syndesmosis: A systematic review with meta-analysis

Netterström-Wedin

Bleakley

2021

Physical Therapy in Sport

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Injury severity at the time of sport-related ankle sprain is associated with symptoms and quality of life in young adults after 3–15 years

Owoeye,

Paz,

Emery

2023

Annals of Medicine

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Background Ankle sprains are the most common sports-related injuries. Individuals with time-loss ankle sprains often experience residual symptoms and chronic ankle instability years after injury. Up to 90% of post-traumatic ankle osteoarthritis cases are associated with severe ankle sprain. This study aimed to examine whether ankle injury severity sustained during youth sports participation is associated with ankle symptoms and function. Materials and Methods Cohort study included 50 young adults (mean age, 23 years) with a 3-to 15-year history of a youth-sport related ‘significant ankle sprain’ (SAS). The primary independent variable was injury severity, which was captured in the index SAS injury details through interviews. SAS was defined as ligament and other intra/extra-articular structure injuries that disrupted youth sport participation, at least 3 days of time loss, and required medical consultation. Severe SAS was defined as SAS involving >28 days of time loss, and non-severe SAS only involved ankle ligaments and/or with ≤28 days of time loss. The Foot and Ankle Outcome Score questionnaire was used to assess ankle symptoms and function. Descriptive statistics and multivariable linear regression models were used to examine the association between SAS severity and outcomes, with sex and time since injury as covariates. Results Compared to participants with non-severe SAS, participants with a history of severe SAS demonstrated significantly poorer outcomes in symptoms [-18.4 (99% CI: −32.2 to −4.6)], pain [-10.1 (99% CI: −19.2 to −1.1)] and QoL [-17.1 (99% CI: −33.1 to −1.1)] in multivariable linear regression models. Conclusions Severe ankle sprain with a loss of > 4 weeks from sports participation at the time of injury is independently associated with poorer ankle symptoms, pain, and ankle-related quality of life after 3–15 years. Secondary prevention measures are needed in individuals with a history of severe ankle sprains to mitigate the potential health consequences.

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Predicting poor outcome from simple ankle injuries: a prospective cohort study

Cited by 5 publications

References 19 publications

Extremity CT and ultrasound in the assessment of ankle injuries: occult fractures and ligament injuries

Extremity CT and ultrasound in the assessment of ankle injuries: occult fractures and ligament injuries

Diagnostic accuracy of clinical tests assessing ligamentous injury of the ankle syndesmosis: A systematic review with meta-analysis

Injury severity at the time of sport-related ankle sprain is associated with symptoms and quality of life in young adults after 3–15 years

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