Vergleich der Sonografie und der Magnetresonanztomografie zur Diagnostik von Rupturen des Lig. deltoideum – gibt es einen Unterschied?

Abstract

US is a reliable procedure for detection of clinically relevant ruptures and uninjured components of the deltoid ligament after distal fibula fractures. However US is not suitable to reliably identify partial ruptures. The treatment decision for operation or conservative treatment of ankle fractures is based on the stability of the ankle. Patients with lateral malleolar fractures and intact medial malleolus but rupture of the deltoid ligament often show a spontaneous reduction of the talus in X-ray images and may therefore be falsely classified as stable (unrecognised medial instability). However, unstable malleolar fractures should be treated with open reduction and internal fixation in order to improve outcome. Hence US is able to influence therapeutic decisions by detecting medial ankle instability, which cannot be detected clinically or radiologically.

The Role of Ultrasound in the Management of Ankle Sprains and a Clinically Relevant Geisinger Ankle Sprain Sports Ultrasound Protocol

“…Following the lateral ankle evaluation, the medial structures are visualized. Due to the role of the deltoid ligament complex in ankle stability, its evaluation is important (27,28). The primary structures include the deltoid ligament complex and the spring ligament.…”

“…3B). Care should be taken when evaluating the tibiotalar ligament complex as it may appear hypoechoic due to its angulation and interspersed fat (27,28). Secondary structures that can be visualized medially include the tibia, talus, calcaneus, tibialis posterior (PT) tendon, flexor hallucis longus (FHL) tendon, and flexor digitorum longus (FDL) tendon.…”

“…The accuracy of physical examination diagnosis of deltoid ligament injuries has not been described, but it has been described in ultrasound. Several studies have shown that ultrasound can diagnose deltoid ligament injuries with a sensitivity of 100% and specificity greater than 92% (27,28,41).…”