Valgus Stress Radiography in Normal Ankles

1997 ◽  
Vol 18 (10) ◽  
pp. 654-657 ◽  
Author(s):  
Jordan Michael Leith ◽  
J.P. McConkey ◽  
David Li ◽  
Bassam Masri
Keyword(s):  
Diagnostic Test ◽  
Ankle Injury ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Stress Radiography ◽  
Valgus Stress ◽  
Complete Rupture ◽  
Talar Tilt ◽  
Standardized Method ◽  
Deltoid Ligament Injury

Deltoid ligament injury is thought to be rare. Signs of complete rupture of the deltoid ligament may be subtle or interpreted as another injury condition and thus are often missed acutely. No standardized method has been created to evaluate medial ligament insufficiency in acute or chronic laxity. To establish a diagnostic test for suspected isolated ruptures of the deltoid ligament, 32 subjects with no previous ankle injury underwent valgus stress radiography and nonstressed radiography of both ankles. Stress radiography in this study showed that there is a measurable but minimal range of talar tilt on valgus stress in previously uninjured ankles. This study provides the basis for diagnosis of the rare isolated rupture of the deltoid ligament of the ankle.

scholarly journals BIMALLEOLAR ANKLE FRACTURE: A SIMPLE FRACTURE?

2017 ◽  
Vol 25 (1) ◽  
pp. 48-51 ◽  
Author(s):  
JUNJI MILLER FUKUYAMA ◽  
ROBINSON ESTEVES SANTOS PIRES ◽  
PEDRO JOSÉ LABRONICI ◽  
JOSÉ OCTÁVIO SOARES HUNGRIA ◽  
RODRIGO LOPES DECUSATI
Keyword(s):  
Ankle Fracture ◽  
Fragment Size ◽  
External Rotation ◽  
Ankle Fractures ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Medial Malleolus ◽  
Level Of Evidence ◽  
Deltoid Ligament Injury ◽  
Supination External Rotation

ABSTRACT Objective: To evaluate the frequency of deltoid ligament injury in bimalleolar supination-external rotation type fractures and whether there is a correlation between the size of the fractured medial malleolus and deltoid ligament injury . Methods: Twenty six consecutive patients underwent magnetic resonance exams after clinical and radiographic diagnosis of bimalleolar supination-external rotation type ankle fractures . Results: Thirteen patients (50%) presented deltoid ligament injury associated to bimalleolar ankle fracture. Partial injury was present in seven (26.9%) patients and total injury in six (23.1%). Regarding medial fragment size, the average was 2.88 cm in the absence of deltoid ligament injury. Partial injuries presented 1.93 cm and total 2.1 cm on average . Conclusion: Deltoid ligament injury was present in 50% of bimalleolar ankle fractures. Smaller medial malleolus fragments, especially concerning the anterior colliculus, presented greater association with partial deltoid ligament injuries. Level of Evidence IV, Cross Sectional Study.

scholarly journals Value of Ultrasound for Stability Assessment of Isolated Lateral Malleolar Fractures Compared to Stress Radiography and Arthroscopy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Young-Uk Park ◽  
Youngwook Seo ◽  
Hyuk Jegal ◽  
Kyung-Tai Lee
Keyword(s):  
Ankle Fracture ◽  
External Rotation ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Stability Assessment ◽  
Stress Radiography ◽  
X Ray ◽  
Malleolar Fractures ◽  
The Stability ◽  
Rotation Stress

Category: Ankle, Trauma Introduction/Purpose: Isolated Lateral malleolus fracture, like any other fractures can be treated by operative or conservative treatment. Stability of ankle joint is the most important factor in deciding the type of treatment. Unstable ankle joints present superior clinical outcomes with surgical management. There are many methods to assess the stability of ankle joint such as plain x- ray films, stress radiographies and physical examination. Many studies have suggested the usage of ultrasound for diagnosis of ankle ligament injury. But, there are no reports about its use for stability assessment of isolated lateral malleolar ankle fracture. Therefore, the purpose of this study is to evaluate the value of ultrasound for stability assessment of isolated lateral malleolar fractures, compared to simple x-ray, stress radiography and arthroscopy. Methods: We have conducted a prospective study which included 13 consecutive patients who underwent arthroscopic exam and subsequent open reduction and internal fixation for isolated lateral malleolar ankle fracture. Before operation simple x-ray, external rotation stress radiographs were done. Stress ultrasound was performed to assess the anterior inferior tibiofibular ligament (AITFL) and medial deltoid ligament prior to operation. The arthroscopic findings were used as the reference standard. A standardized physical examination (tenderness and ecchymosis, external rotation stress test), simple radiography, stress radiography and ultrasound images were compared to assess the stability. Results: Deltoid ligament injury and or syndesmosis injury were verified arthroscopically in 12 cases with a clinical diagnosis (92.3%). There were 9 cases who showed unstable ankle fracture on the simple radiography. (69.2%). There were all cases who showed unstable ankle fracture on the external rotation stress radiography. (100%) In addition, for 12/13, there were acute tear of the deltoid ligament or AITFL injury on the ultrasound (92.3%). Conclusion: The results suggest that ultrasound could be used for the assessment of the instability of isolated lateral malleolar fracture.

scholarly journals Diagnosis and Management of Deltoid Ligament Insufficiency

2019 ◽  
Vol 4 (3) ◽  
pp. 247301141986007
Author(s):  
Sarup S. Sridharan ◽  
Andrew Dodd
Keyword(s):  
Systematic Review ◽  
Diagnostic Imaging ◽  
Diagnostic Criteria ◽  
Ankle Instability ◽  
Specific Treatment ◽  
Chronic Ankle Instability ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Objective Data ◽  
Deltoid Ligament Injury

Background: Surgical management of patients with acute and chronic ankle instability (CAI) has historically focused on the lateral ligament complex. Recent studies in CAI patients have shown that magnetic resonance imaging (MRI) and arthroscopy demonstrate concomitant injury to the deltoid ligament complex We performed a systematic review to determine if consistent clinical, diagnostic imaging, or arthroscopic findings of deltoid ligament injury in the setting of CAI have been described. In addition, we sought to determine if treatment options and/or clinical outcomes have been described. Methods: A systematic review was conducted using the PubMed, MEDLINE, and Embase databases. Articles were included if they had a majority of patients 18 years of age or older, focused on deltoid ligament injury in ankle instability, and reported diagnostic and/or treatment methods. Articles were excluded if the study focused on the deltoid ligament in the acute fracture setting. All included articles were assessed for diagnostic criteria, treatments, and patient outcomes. Results: Our search yielded 157 articles, of which a total of 13 were included in our study. Arthroscopy was described as the gold standard to diagnose and evaluate the severity of deltoid ligament injury, however, little objective data on the arthroscopic diagnosis of deltoid ligament insufficiency was reported. MRI was the imaging modality of choice to evaluate deltoid ligament injury and had a high sensitivity and specificity when compared with arthroscopy. No standard MRI diagnostic criteria for deltoid ligament injury were identified in the literature. Specific treatment techniques and long-term outcomes were not well described in the manuscripts included in this review. Conclusion: There is limited knowledge on deltoid ligament insufficiency in the setting of chronic ankle instability. Criteria for characterizing deltoid ligament damage with diagnostic imaging appear to be evolving, but there is no standard classification. Only 1 author has described a method to evaluate deltoid ligament competency on arthroscopic examination. There are currently no objective data to guide treatment decisions. Level of Evidence: Level III.

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