Weightbearing Radiographs Facilitate Functional Treatment of Ankle Fractures of Uncertain Stability

Hastie, Graham R; Akhtar, Sabeen; Butt, Usman Ismat; Baumann, Andreas; Barrie, J.

doi:10.1053/j.jfas.2015.04.025

Cited by 31 publications

(26 citation statements)

References 25 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%

“…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%

“…ER stress testing typically requires clinicians with surgical experience (19), and weight-bearing radiographs may not be possible initially, due to pain. Therefore, an early control visit is often needed (20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Others have advocated for the use of weight-bearing radiographs, because gravity stress radiographs might overestimate the number of unstable ankle fractures (3)(4)(5)(6)(7)18). In these studies, weight-bearing radiographs have been shown to be predictive of stability, and patients with a normal mortise relationship can be successfully managed with immediate protected weight-bearing and functional treatment.…”

Section: Brief Reportmentioning

confidence: 99%

“…Undisplaced or minimally displaced lateral malleolus fractures without medial injury are likely to be stable, and can be treated non-operatively with functional bracing and early mobilization (3)(4)(5)(6)(7). Lateral malleolar fractures with medial injury may be unstable, and are more frequently treated by operative reduction and internal…”

Section: Introductionmentioning

confidence: 99%

Weight bearing cone beam CT scan versus gravity stress radiography for analysis of supination external rotation injuries of the ankle

Marzo¹,

Kluczynski²,

Clyde³

et al. 2017

Quant. Imaging Med. Surg.

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For AO 44-B2 ankle fractures of uncertain stability, the current diagnostic standard is to obtain a gravity stress radiograph, but some have advocated for the use of weight-bearing radiographs. The primary aim was to compare measures of medial clear space (MCS) on weight-bearing cone beam computed tomography (CBCT) scans versus gravity stress radiographs for determining the state of stability of ankle fractures classified as AO SER 44-B2 or Weber B. The secondary aim was to evaluate the details offered by CBCT scans with respect to other findings that may be relevant to patient care. Nine patients were enrolled in this cross-sectional study between April 2016 and February 2017 if they had an AO SER 44-B2 fracture of uncertain stability, had a gravity stress radiograph, and were able to undergo CT scan within seven days.The width of the MCS was measured at the level of the talar dome on all radiographs and at the mid coronal slice on CT. Wilcoxon signed-ranks tests were used to compare MCS between initial radiographs, gravity stress radiographs and weight-bearing CBCT scans. MCS on weight-bearing CBCT scan (1.41±0.41 mm) was significantly less than standard radiographs (3.28±1.63 mm, P=0.004) and gravity stress radiographs (5.82±1.93 mm, P=0.02). There was no statistically significant difference in MCS measured on standard radiographs versus gravity stress radiographs (P=0.11). Detailed review of the multiplanar CT images revealed less than perfect anatomical reduction of the fractures, with residual fibular shortening, posterior displacement, and fracture fragments in the incisura as typical findings. Similar to weight-bearing radiographs, weight-bearing CBCT scan can predict stability of AO 44-B2 ankle fractures by showing restoration of the MCS, and might be used to indicate patients for non-operative treatment. None of the fractures imaged in this study were perfectly reduced however, and further clinical research is necessary to determine if any of the detailed weight-bearing CBCT findings are related to patient outcomes.

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

Leeuwen

Haak

Kop

et al. 2018

Eur J Trauma Emerg Surg

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Weightbearing Radiographs Facilitate Functional Treatment of Ankle Fractures of Uncertain Stability

Cited by 31 publications

References 25 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

Weight bearing cone beam CT scan versus gravity stress radiography for analysis of supination external rotation injuries of the ankle

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

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