Stability Assessment of the Ankle Mortise in Supination-External Rotation-Type Ankle Fractures: Lack of Additional Diagnostic Value of MRI

Nortunen, Simo; Lepojärvi, Sannamari; Savola, Olli; Niinimäki, Jaakko; Ohtonen, Pasi; Flinkkilä, Tapio; Lantto, Iikka; Kortekangas, Tero; Pakarinen, Harri

doi:10.2106/jbjs.m.01533

Cited by 62 publications

(79 citation statements)

References 50 publications

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“…Previously, an analysis of standard, non-stress radiographs alone was considered insufficient to determine the stability of the ankle mortise in patients with this type of isolated SER fracture (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). We also found that female sex and only two fracture fragments were independent factors for predicting ankle mortise stability.…”

Section: Discussionmentioning

confidence: 73%

“…The evaluator was blinded to the measurements of standard radiographs. The ankle mortise was considered unstable when the MCS was 5 mm, and at least 1 mm larger than the superior tibiotalar clear space (15).…”

Section: Radiographic Measurementsmentioning

confidence: 99%

“…Consequently, further imaging, either static or dynamic, has been advised. Magnetic resonance imaging (MRI) studies have reported that the deltoid ligament is always injured to some degree in SER-type fractures (13)(14)(15). However, due to its moderate reliability, the MRI offers limited value to clinical decisionmaking (15).…”

Section: Introductionmentioning

confidence: 99%

“…However, due to its moderate reliability, the MRI offers limited value to clinical decisionmaking (15). Alternatively, manual external-rotation (ER) stress radiographs (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), gravity stress tests (16)(17)(18)(19), or weight-bearing radiographs (20)(21)(22) have been used to quantify possible dynamic instability. Computer tomography (CT) has mainly been used in research settings (23,24).…”

Section: Introductionmentioning

confidence: 99%

“…There is no "gold standard" method for evaluating the stability of the ankle mortise; however, external-rotation (ER) stress radiographs have been studied most extensively (6,7,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). ER stress testing typically requires clinicians with surgical experience (19), and weight-bearing radiographs may not be possible initially, due to pain.…”

Section: Introductionmentioning

confidence: 99%

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Dynamic Stress Testing Is Unnecessary for Unimalleolar Supination-External Rotation Ankle Fractures with Minimal Fracture Displacement on Lateral Radiographs

Nortunen

Leskelä

Haapasalo

et al. 2017

The Journal of Bone and Joint Surgery

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Section: Discussionmentioning

confidence: 73%

Section: Radiographic Measurementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dynamic Stress Testing Is Unnecessary for Unimalleolar Supination-External Rotation Ankle Fractures with Minimal Fracture Displacement on Lateral Radiographs

Nortunen

Leskelä

Haapasalo

et al. 2017

The Journal of Bone and Joint Surgery

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Deltoid ligament injuries: A review of the anatomy, diagnosis and treatments

Koris,

Calder,

Dalmau‐Pastor

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeAnkle sprains remain the most common soft tissue injury presenting to Emergency Departments. Recently, there has been increased awareness and reporting of deltoid ligament injuries in association with injuries to the lateral ligament complex as well as with fibula fractures. This article reviews the currently available literature on the anatomy of the deltoid ligament, clinical and radiological diagnosis of injuries to the deltoid ligament and treatment recommendations.MethodsA literature review was conducted for keywords associated with deltoid ligament injuries. MEDLINE, PubMed and Embase databases were utilised for this search. Articles were included if involving an adult population, were English‐language, were related to deltoid ligament injuries (with or without associated injuries) and reported on patho‐anatomy, clinical or radiological diagnosis or treatment methods.ResultsA total of 93 articles were assessed for relevance from the database search, and 47 were included after the removal of irrelevant articles and duplicates. Several studies reported on the clinical findings of deltoid ligament injury, as well as the radiographic analysis. Arthroscopy was considered the gold standard of diagnosis, with authors reporting on the potential benefit of performing arthroscopic repair or reconstruction at the same time. There were no studies that provided a system for the classification of deltoid ligament injury or larger studies of treatment pathways. Long‐term studies of the incidence of instability in deltoid ligament injuries were not available.ConclusionThere is limited evidence available regarding deltoid ligament injuries, particularly in terms of treatment options, either in isolation or with concomitant injuries. Long‐term follow‐up studies are needed to obtain more accurate data on the number of complications.Level of EvidenceLevel IV.

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Ankle Joint

Khodaee¹,

Gammons²,

Hunt³

2020

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Stability Assessment of the Ankle Mortise in Supination-External Rotation-Type Ankle Fractures: Lack of Additional Diagnostic Value of MRI

Abstract: On the basis of the study results, we do not recommend the use of MRI when choosing between operative and nonoperative treatment of an SER-type ankle fracture.

Cited by 62 publications

References 50 publications

Dynamic Stress Testing Is Unnecessary for Unimalleolar Supination-External Rotation Ankle Fractures with Minimal Fracture Displacement on Lateral Radiographs

Dynamic Stress Testing Is Unnecessary for Unimalleolar Supination-External Rotation Ankle Fractures with Minimal Fracture Displacement on Lateral Radiographs

Deltoid ligament injuries: A review of the anatomy, diagnosis and treatments

Ankle Joint

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