Stress Examination of Supination External Rotation-Type Fibular Fractures

McConnell, T. R.; Creevy, William R.; Tornetta, Paul

doi:10.2106/00004623-200410000-00007

Cited by 169 publications

(207 citation statements)

References 16 publications

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“…Recent studies showed that these signs are not reliable [12,16,29] and we are of the opinion that the stress radiographs are more reliable. Today there is no clear review, and there is no evidence-based Xow chart as to how to evaluate deltoid ligament integrity.…”

Section: Introductionmentioning

confidence: 79%

“…An overview is shown in Tables 1 and 2. Three trails investigated medial tenderness [12,16,29]; two studies, ecchymosis [16,29]; two studies, swelling [16,29]; one study, an injury radiograph [46]; six studies, a type of radiographic stress view [12,16,18,29,32,35,45]; one study, the Lauge-Hansen classiWcation [46]; one study, MRI [24]; and one article studied arthroscopy [46] in the evaluation of the deltoid ligament integrity. The publication dates span 6 years; in 2001, Michelson et al [32] was the earliest and in 2007, Koval et al [24] and Schock et al [45] were the most recent publications.…”

Section: Resultsmentioning

confidence: 99%

“…They found a range of sensitivities from 20 to 56% and speciWcities from 71 to 97%. McConell et al [29] reported a 56% positive predictive value for severe tenderness as a predictor of a rupture. DeAngelis et al [12] No correlation of medial tenderness with positive stress radiographs Park et al [35] Stress radiographs in dorsiXexion/external rotation were most predictive…”

Section: Physical Examinationmentioning

confidence: 99%

“…McConnell et al [29] Soft-tissue indicators are not accurate predictors of instability Gill et al [18] Manual is equivalent to gravity-stress radiographs Egol et al [16] Medial tenderness, swelling, and ecchymosis were not sensitive in predicting instability…”

Section: Physical Examinationmentioning

confidence: 99%

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Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature

Bekerom

Mutsaerts

Dijk

2008

Arch Orthop Trauma Surg

111

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Background and purpose Review the literature concerning modalities to evaluate the integrity of the deltoid ligament in patients with supination external rotation ankle fractures. Methods The electronic databases Pubmed/Medline, CINAHL and Embase were searched from 1987 to November 2007 to identify all published original studies concerning diagnostic modalities to evaluate the integrity of the deltoid ligament in adult ankle fractures. Results This review included nine studies involving 423 ankle fractures. Three trails investigated medial tenderness; two studies, ecchymosis; two studies, swelling; one study, an injury radiograph; six studies, a type of radiographic stress view; one study, the Lauge-Hansen classiWcation; one study, MRI; and one article studied arthroscopy in the evaluation of the deltoid ligament integrity. Interpretation Swelling, ecchymosis, medial tenderness, initial injury radiographs and the Lauge-Hansen classiWcation are less adequate predictors of the integrity of the deltoid ligament. Manual or the less painful variant, the gravity external rotation stress radiographs are considered the gold standard. The amount of medial clear space widening indicative of a positive external rotation stress test has been somewhat variable in the literature but ¸5 mm is generally regarded as most reliable. Achieving adequate external rotation of the foot when obtaining stress radiographs is more important than positioning the ankle in the appropriate degree of ankle Xexion. The amount of applied force necessary when performing an external rotation stress radiograph is not well deWned and mainly determined by the patient's pain level. The indication for surgery should not be based on the absolute value of one parameter but on the combination of several parameters. If nonoperative treatment is chosen despite a positive stress radiograph, close follow-up is critical because subluxation of the ankle joint is still possible. MRI could be useful in individual cases.

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Section: Introductionmentioning

confidence: 79%

Section: Resultsmentioning

confidence: 99%

Section: Physical Examinationmentioning

confidence: 99%

Section: Physical Examinationmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature

Bekerom

Mutsaerts

Dijk

2008

Arch Orthop Trauma Surg

111

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“…These signs were thought to suggest deltoid ligament rupture; however, recent literature is replete with data that clinical symptoms of medial tenderness, swelling, and ecchymosis are not predictive of deltoid ligament disruption. 16,17 Because of the uncertainty in these physical findings, clinicians rely more on gravity stress or medial stress radiographs. These radiographs apply force by either gravity or manual rotation to the deltoid ligament complex.…”

Section: 3mentioning

confidence: 99%

Evaluation of the Deltoid Complex in Supination External Rotation Ankle Fractures

Motley¹,

Carpenter²,

Clements³

et al. 2010

FAOJ

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The Foot and Ankle Online Journal 3 (4): 1We present the results of a prospective study of supination external rotation ankle injuries with an isolated fibula fracture on plain radiographs. SER injuries begin anteriorly and progress in a clockwise fashion so that stage I injury includes the anterior inferior tibiofibular ligament. As rotation of the talus continues, stage II will involve either rupture of the lateral ankle ligaments or a fracture of the fibula at the level of the ankle joint. With continued progression, stage III involves either an injury to the posterior talofibular ligament or an avulsion injury of the posterior malleolus. Stage IV includes injury to either the deltoid ligament complex or a fracture of the medial malleolus. The surgeon can easily determine that the fracture is unstable when the medial malleolus is broken. However, determining fracture instability based on deltoid ligament competency is more challenging.

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Malleolar Fractures

Sanders¹,

Manjoo²

2011

Evidence‐Based Orthopedics

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Stress Examination of Supination External Rotation-Type Fibular Fractures

Cited by 169 publications

References 16 publications

Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature

Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature

Evaluation of the Deltoid Complex in Supination External Rotation Ankle Fractures

Malleolar Fractures

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