The additional value of gravity stress radiographs in predicting deep deltoid ligament integrity in supination external rotation ankle fractures

Leeuwen, Claar van; Haak, Timo; Kop, Marnix P. M.; Weil, Nikki L.; Zijta, Frank M.; Hoogendoorn, J. M.

doi:10.1007/s00068-018-0923-x

Cited by 20 publications

(14 citation statements)

References 38 publications

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“…32 However, in 7.7% of fractures with MCS >6 mm the DDL was proven to be intact. 31 Theoretically, the percentage of fractures with MCS 4-6 mm but an intact DDL will be even higher. This presumably leads to operative overtreatment of stable fractures when using the cutoff value MCS >4 mm for operative treatment.…”

Section: Discussionmentioning

confidence: 97%

“…One of our former trials, which has recently been expanded with new data, shows that in stable type B ankle fractures (without rupture on MRI scan), the GS radiograph has a physiological MCS widening of 1.2 mm more than the regular mortise view. 31 Pitakveerakul et al 23 described that even in nonfractured ankles, there is a significantly wider MCS on GS radiograph than on mortise view. They studied normative radiographic data for GS radiographs in 120 healthy patients without fracture.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study compared the GS radiograph with results of the MRI and found a sensitivity of 100 and specificity of 91.7 for the GS radiograph to determine DDL rupture using an MCS cutoff value ≥6 mm. 31 However, the number of DDL ruptures of their cohort of 39 patients was limited.…”

Section: Discussionmentioning

confidence: 99%

“…All 90 patients with an isolated type B distal fibular fracture that were included in this study underwent an additional MRI scan of the ankle, which findings influenced the treatment decision. 31…”

Section: Methodsmentioning

confidence: 99%

“…In Weber type B ankle fractures, it is important to determine stability and congruency of the ankle joint. 31 The current consensus is that stable fractures with no dislocation can safely be treated conservatively. In the case of an incongruent ankle joint with proven instability, operative treatment is needed.…”

Section: Introductionmentioning

confidence: 99%

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The Value of Additional Gravity Stress Radiographs for Decision Making in the Treatment of Isolated Type B Distal Fibular Fractures

et al. 2021

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Background: Prior to treatment decisions concerning isolated Weber type B ankle fractures, assessment of the stability of the ankle joint is mandatory. The gravity stress (GS) radiograph is a radiographic tool to determine stability. We hypothesized that this additional GS radiograph would lead to fewer operative treatments by applying the criterion of operative treatment when medial clear space (MCS) > superior clear space (SCS) + 2 mm on the GS radiograph, compared with the nonstressed mortise view criteria of advising operative treatment in case of MCS > SCS + 1 mm. Methods: This retrospective comparative cohort study analyzed 343 patients aged between 18 and 70 years with an isolated Weber type B ankle fracture diagnosed at the emergency department between January 2014 and December 2019. The cohort was divided into 2 groups based on whether an additional GS radiograph was performed. Group I consisted of 151 patients in whom a regular mortise and lateral radiograph were performed. Group II comprised 192 patients, with an additional GS radiograph. Primary outcome was type of treatment (conservative vs operative). Secondary outcomes were patient-reported functional outcomes and pain. Results: Baseline characteristics of both groups did not differ. In group I, surgery was performed in 60 patients (39.7%) compared with 108 patients (56.3%) in group II ( P = .002). In the operatively treated patients, the mean MCS on regular mortise view was significantly smaller in patients in whom an additional GS radiograph was performed compared to patients without an additional GS radiograph (4.1 mm vs 5.2 mm, P < .001). Mean Olerud-Molander Ankle Score and mean visual analog scale (VAS) for pain did not differ significantly between groups I and II. Conclusions: Contrary to what was hypothesized, the introduction of an additional gravity stress radiograph, by which operative treatment was indicated if the MCS was wider than the SCS + 2 mm, did not result in reduced operative treatment of Weber type B ankle fractures when operative treatment was indicated for MCS > SCS + 1 mm on non-gravity stress radiographs. Level of Evidence: Level III: retrospective comparative study.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Value of Additional Gravity Stress Radiographs for Decision Making in the Treatment of Isolated Type B Distal Fibular Fractures

et al. 2021

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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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Deltoid Ligament Injuries in Ankle Fractures

Hintermann

Ruiz

2021

Foot and Ankle Instability

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The additional value of gravity stress radiographs in predicting deep deltoid ligament integrity in supination external rotation ankle fractures

Abstract: Gravity stress radiographs have more discriminative ability for diagnosing SER-type fractures with or without a complete deltoid ligament tear than regular ankle mortise views.

Cited by 20 publications

References 38 publications

The Value of Additional Gravity Stress Radiographs for Decision Making in the Treatment of Isolated Type B Distal Fibular Fractures

The Value of Additional Gravity Stress Radiographs for Decision Making in the Treatment of Isolated Type B Distal Fibular Fractures

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

Deltoid Ligament Injuries in Ankle Fractures

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