Prevalence of associated ligamentous ankle injuries with an isolated lateral malleolus fracture

Abstract

Background: Magnetic resonance image (MRI) was used with plain radiographic views for evaluation of bone and ligamentous injuries to detect any missing osteo-ligamentous injuries using single imaging modality. The purpose of this study was to ascertain the prevalence of associated ligamentous ankle injuries with an apparently isolated lateral malleolus fracture using MRI. Methods: This cross-sectional study was carried on 100 eligible patients with an acute isolated lateral malleolus closed fracture. Every patient underwent a history taking and clinical assessment (general and local assessment including inspection, palpation and neurovascular assessment of the affected lower limb) and full investigations. Imaging was done using Plain X-rays (anteroposterior, lateral, mortise and stress views) and MRI. Results: There was a significant relationship between the tenderness on medial side and Weber classification, Lauga Hansen classification and deltoid ligament injury (posterior tibiotalar ligament (PTTL), anterior tibiotalar ligament (ATTL) and tibiocalcaneal ligament (TCL)) (P value <0.001). There was an insignificant relation between radiographic anterior-posterior (AP) medial clear space (MCS) and (PTTL and ATTL), syndesmotic and Lateral collateral ligament injuries. There was a significant relationship between missed deltoid injuries with weber and Lauge. Hansen classification (P =0.005). Conclusions: MRI is valuable in the assessment of radiologically isolated lateral malleolus fracture cases. MCS in AP and stress views was insignificantly correlated to deltoid ligament injury, syndesmotic ligaments injury and lateral collateral ligaments injuries however, there was a strong link between syndesmotic ligaments injuries and both tibiofibular overlap (TFO) and tibiofibular clear space (TFCS) in AP and stress views.