Ankle Fracture Classification: A Comparison of Reliability of Three X-ray Views Versus Two

1998 ◽  
Vol 19 (8) ◽  
pp. 555-562 ◽  
Author(s):  
Michael E. Brage ◽  
Matthew Rockett ◽  
Robert Vraney ◽  
Robert Anderson ◽  
Alicia Toledano
Keyword(s):  
Ankle Fracture ◽  
Ankle Injury ◽  
Ankle Fractures ◽  
Kappa Statistics ◽  
Fracture Classification ◽  
X Ray ◽  
Good Accord ◽  
Interexaminer Reliability ◽  
Intraexaminer Reliability ◽  
Good Agreement

Our hypothesis was that malleolar ankle fractures could be classified with two radiographic views as reliably as with three views. Four different observers independently evaluated 99 sets of ankle radiographs. The examiners classified the ankle fractures by using both the Lauge-Hansen and Danis-Weber systems. The interobserver and intraobserver variations were analyzed by kappa statistics. With regard to intraexaminer reliability, the examiners demonstrated excellent accord in classifying the fractures in the Danis-Weber system with either three views or two views. The kappa values were comparable. In the Lauge-Hansen system, three examiners demonstrated excellent accord and one examiner demonstrated good accord in classifying the fractures. Similar kappa values were generated when examiners classified fractures with either three views or two views. With regard to interexaminer reliability, good to excellent accord was demonstrated overall among the four examiners when they used the Danis-Weber system with either three views or two views. The examiners were in good agreement when they used the Lauge-Hansen system. Similar kappa values were generated whether the examiners used three views or two views. Three radiographic views are usually ordered for evaluation of an acute ankle injury. Previous studies have shown that only two views are needed for diagnosis of a malleolar ankle fracture. This study demonstrates that malleolar ankle fractures can be classified with two views, lateral or mortise, with a reliability as good as that achieved with three views. The best agreement is achieved with lateral and mortise views.

Medical Image Analysis and Correlation Between Ankle Fracture Classification and Ankle Computed Tomography

2020 ◽  
Vol 10 (12) ◽  
pp. 2935-2939
Author(s):  
Yugang Teng ◽  
Yuanzhen Zhang ◽  
Zhenyu Wang
Keyword(s):  
Computed Tomography ◽  
Cross Section ◽  
Ankle Fracture ◽  
Medical Image Analysis ◽  
Ct Images ◽  
Ankle Fractures ◽  
Fracture Classification ◽  
Horizontal Cross Section ◽  
X Ray ◽  
The Relationship

Objective: In this paper, we summarize computed tomography (CT) manifestations and characteristics of ankle fractures, and analyze the relationship between CT images and common ankle fracture classifications. Methods: A retrospective survey of 369 adult ankle fractures was performed. CT images of 1 cm horizontal cross-section above the ankle points and their characteristics were analyzed. Ankle fracture X-ray classification was performed, and the relationship between CT images and fracture X-ray classification was analyzed. Results: There is a correlation between CT images and Danis-Weber classification. The incidence of IOL fractures varies with the severity of Danis-Weber classification. After rank correlation test, the difference is statistically significant (Spearman R = 0.781,P < 0.001). CT images can detect IOL fractures that cannot be judged by X-ray fracture classification, and the incidence rate is 5.9%. Conclusions: The 1 cm horizontal cross-section CT image on the ankle point can clearly determine the combined tibiofibular IOL injury before surgery, and it has a good correlation with the Danis-Weber fracture classification, and can detect unexplainable IOL fractures in some radiographs.

scholarly journals Does Patient Self-Awareness Predict Ankle Fractures?

2021 ◽  
Vol 8 ◽  
Author(s):  
Shaza Aouthmany ◽  
Tymon Horn ◽  
Michelle Howe ◽  
Edward Kakish ◽  
Alana Kakish ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The United States ◽  
Ankle Fractures ◽  
Ankle Injuries ◽  
Self Awareness ◽  
Self Assessment ◽  
X Ray ◽  
Decision Making Processes

Introduction: Ankle injuries represent one of the most common sports and extremity related complaints presented in emergency departments (ED) with over five million ankle injuries annually arising in the United States. The 2007 US National Health Statistics Report stated that lower limb and ankle complaints accounted for 4.1% of all reported body sites undergoing injury in the ED. The purpose of this study was to examine how frequently a sample of ED patients’ perception of having a possible ankle fracture was predictively associated with results of their X-ray evaluation results. Methods: After 2017 IRB approval, a sample of consented adult patients receiving care at the authors’ two Ohio and Michigan ED were asked, “Do you think you broke your ankle?” Regardless of each patient’s answer, they received an X-ray to evaluate for an ankle fracture that was interpreted by a radiologist. Results: A total of 69 eligible patients received an ankle X-ray. The total number of ankle fractures confirmed by X-ray was 20 (29.4% of sample) while 48 (70.5%) of ankles that were X-rayed were not fractured. Six (28.5%) out of 21 males and 14 (30.4%) out of 46 females were found to have a confirmed ankle fracture. The sensitivity of the perceived ankle fracture question was at or below 50% in all sample subgroups except for smokers at 67%. Conclusion: These findings support the importance of an ED clinician’s intuition when considering a patient’s own self-assessment during their clinical decision-making processes

scholarly journals Ankle Fracture Stability-based Classification

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0034
Author(s):  
James Michelson ◽  
John Delaney
Keyword(s):  
Classification System ◽  
Ankle Fracture ◽  
Area Under The Curve ◽  
Positive Outcome ◽  
Classification Systems ◽  
Ankle Fractures ◽  
Kappa Statistics ◽  
Pathologic Fractures ◽  
The Stability ◽  
Excellent Reproducibility

Category: Trauma Introduction/Purpose: Rotational ankle fractures are common in orthopaedic surgery, however existing classification systems are mostly descriptive in nature and do not explicitly guide surgical decision-making. A Stability-Based classification was developed recently to provide a more prognostic classification. The purpose of this study was to compare the reproducibility of existing ankle fracture classifications, and determine the ability of the Stability-Based classification to predict clinical treatment. Methods: One hundred ninety-three consecutive ankle fractures treated at our institution were retrospectively analyzed. Rotational type injury patterns in patients >18 years old were included. None of the subjects were clinically treated or evaluated by the study authors. The fractures were treated by attending physicians who were unaware of the Stability-Based classification system. Pathologic fractures were excluded. Three observers classified injury radiographs using the Lauge-Hansen, Weber/AO, and Stability-Based classifications systems. Reproducibility (inter-observer variation) of each classification system was calculated using kappa statistics. Prognostic values were evaluated by calculating the area under the curve (AUC) for the ROC curves (using surgery as the positive outcome) for each classification. Results: The Stability-Based classification was showed the excellent reproducibility (kappa .938, 95% CI .921-.952), along with the Weber/AO classification (kappa .97, 95% CI .961-.976), while the Lauge-Hansen had the lowest reproducibility (kappa .74, 95%CI .664-.795). The AUC for the three classifications were .883 (95%CI .852-.914), .626 (95%CI .576-.675), and .698 (95%CI .641-.755), respectively (Figure 1). The AUC was significantly better for the Stability-Based classification compared to the other 2 classifications (p<.001). Conclusion: The AO/Weber classification had excellent reproducibility, but did not predict the need for surgical stabilization accurately. In contrast, the Stability-Based classification system was both highly reproducible (kappa .938) with excellent prognostic ability to identify patients who got surgery (AUC .883). Furthermore, there were no patients who were classified as stable who failed non-operative treatment. The Stability-Based classification was found to have superior prognostic capacity compared to both the Lauge-Hansen and AO/Weber classification systems. This extends earlier studies by showing the reproducibility of the Stability-Based classification system and directly demonstrating its prognostic superiority to other classification systems.

scholarly journals The Value of CT 3D Reconstruction in the Classification and Nursing Effect Evaluation of Ankle Fracture

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Pan Xue ◽  
Xue Chen ◽  
Si Chen ◽  
Yuanyuan Shi
Keyword(s):  
3D Reconstruction ◽  
Ankle Fracture ◽  
Spiral Ct ◽  
Fracture Classification ◽  
Effect Evaluation ◽  
X Ray ◽  
Early Classification ◽  
First Choice ◽  
Different Types

Aim. To study the application value of ankle fracture classification and diagnosis. In this paper, the clinical data of 100 cases of ankle fracture patients admitted from May 2020 to May 2021 were analyzed by CT 3D reconstruction. All patients received surgical treatment and underwent spiral CT 3D reconstruction and X-ray examination before surgery. The results showed that 20 cases (20.00%) of the 100 cases were PER, 24 cases (24%) of the 100 cases were PAB, 31 cases (31%) of the 100 cases were SER, and 25 cases (25%) of the 100 cases were SAB, respectively. Conclusion. The diagnostic accuracy of CT 3D reconstruction for different types of ankle fracture is higher than that of X-ray, and the differences are statistically significant ( P < 0.05 ). CT 3D reconstruction is applied in the early diagnosis of ankle fracture, which can accurately detect the classification of patients. It has important clinical application value and can be used as the first choice for the early classification diagnosis of ankle fracture.

Ankle Fracture Classification Systems: A Case for Integration of the Lauge-Hansen and AO-Danis-Weber Schemes

Foot & Ankle ◽  
1992 ◽  
Vol 13 (7) ◽  
pp. 404-407 ◽  
Author(s):  
Marion C. Harper
Keyword(s):  
Ankle Fracture ◽  
External Rotation ◽  
Classification Systems ◽  
Ankle Fractures ◽  
Fracture Classification ◽  
Relative Simplicity ◽  
Advantages And Disadvantages ◽  
Rotation Pattern ◽  
Fracture Classification Systems ◽  
Pronation External Rotation

The two dominant classification systems for ankle fractures in use are the Lauge-Hansen and AO-Danis-Weber schemes. Each has certain advantages and disadvantages. Because of basic similarities, integration of these systems into one scheme involving three basic patterns with appropriate staging appears to be reasonable. This integration is based upon combining the pronation-abduction and pronation-external rotation injuries in Lauge-Hansen's scheme into one pronation-abduction-external rotation pattern. The resultant system would appear attractive in terms of combining relative simplicity with completeness.

scholarly journals Application of X-ray image measurement in the early diagnosis of sports injury of ankle ligament

2021 ◽  
Vol 37 (6-WIT) ◽  
Author(s):  
Shuqiao Meng ◽  
Wenxia Tong ◽  
Shanshan Han
Keyword(s):  
Ankle Fracture ◽  
Sports Injury ◽  
Injury Mechanism ◽  
Ankle Fractures ◽  
Analysis Method ◽  
X Ray ◽  
Ankle Ligament ◽  
Group A ◽  
Wrong Diagnosis ◽  
Group B

Objectives: To study the value of X-ray analysis method of ankle fracture based on injury mechanism to improve the imaging diagnosis level of ankle fracture. Methods: This study was conducted from January 2016 to December 2019. It included 105 cases of fractures caused by sprained ankle joints. Their age was between 21-81 years with an average of 49.5 years, The traditional X-ray analysis method (Group-A) and the injury mechanism-based ankle fracture X-ray analysis method (Group-B) were used to analyze X-ray image data. Group-B also performed Weber classification and Lauge-Hansen classification on cases. Installment. Results: Of the 105 patients with ankle fractures, 97 patients in Group-B were able to make Lauge-Hansen classification. Of these 97 ankle fractures, 137 were found in Group-A, and 158 were found in Group-B. The wrong diagnosis of fracture in Group-A was 18%, and the wrong diagnosis of fracture in Group-B was 0.5%. There was a statistically significant difference between the two groups (P <0.05). Conclusion: The X-ray analysis method of ankle fractures based on injury mechanism can effectively improve the detection rate of hidden ankle fractures and high fibular fractures, and reduce the missed diagnosis, which is superior to the traditional X-ray analysis methods. At the same time, Weber classification, Lauge-Hansen classification and staging can be made for most cases, which is conducive to guiding clinical treatment. doi: https://doi.org/10.12669/pjms.37.6-WIT.4841 How to cite this:Meng S, Tong W, Han S. Application of X-ray image measurement in the early diagnosis of sports injury of ankle ligament. Pak J Med Sci. 2021;37(6):1580-1584. doi: https://doi.org/10.12669/pjms.37.6-WIT.4841 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Ankle Fracture Classification: An Innovative System for Describing Ankle Fractures

2019 ◽  
Vol 58 (3) ◽  
pp. 492-496 ◽  
Author(s):  
Jan Paul Briet ◽  
Falco Hietbrink ◽  
Diederik P. Smeeing ◽  
Marcel G.W. Dijkgraaf ◽  
Egbert Jan Verleisdonk ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Ankle Fractures ◽  
Fracture Classification ◽  
Innovative System

Atomic Layer Deposition of LiF and Lithium Ion Conducting (AlF3)(LiF)x Alloys Using Trimethylaluminum, Lithium Hexamethyldisilazide and Hydrogen Fluoride

2017 ◽  
Author(s):  
Younghee Lee ◽  
Daniela M. Piper ◽  
Andrew S. Cavanagh ◽  
Matthias J. Young ◽  
Se-Hee Lee ◽  
...  
Keyword(s):  
Lithium Ion ◽  
Atomic Layer ◽  
Mass Gain ◽  
Alloy Film ◽  
Ex Situ ◽  
X Ray ◽  
Layer Deposition ◽  
Ion Conducting ◽  
Good Agreement

<div>Atomic layer deposition (ALD) of LiF and lithium ion conducting (AlF<sub>3</sub>)(LiF)<sub>x</sub> alloys was developed using trimethylaluminum, lithium hexamethyldisilazide (LiHMDS) and hydrogen fluoride derived from HF-pyridine solution. ALD of LiF was studied using in situ quartz crystal microbalance (QCM) and in situ quadrupole mass spectrometer (QMS) at reaction temperatures between 125°C and 250°C. A mass gain per cycle of 12 ng/(cm<sup>2</sup> cycle) was obtained from QCM measurements at 150°C and decreased at higher temperatures. QMS detected FSi(CH<sub>3</sub>)<sub>3</sub> as a reaction byproduct instead of HMDS at 150°C. LiF ALD showed self-limiting behavior. Ex situ measurements using X-ray reflectivity (XRR) and spectroscopic ellipsometry (SE) showed a growth rate of 0.5-0.6 Å/cycle, in good agreement with the in situ QCM measurements.</div><div>ALD of lithium ion conducting (AlF3)(LiF)x alloys was also demonstrated using in situ QCM and in situ QMS at reaction temperatures at 150°C A mass gain per sequence of 22 ng/(cm<sup>2</sup> cycle) was obtained from QCM measurements at 150°C. Ex situ measurements using XRR and SE showed a linear growth rate of 0.9 Å/sequence, in good agreement with the in situ QCM measurements. Stoichiometry between AlF<sub>3</sub> and LiF by QCM experiment was calculated to 1:2.8. XPS showed LiF film consist of lithium and fluorine. XPS also showed (AlF<sub>3</sub>)(LiF)x alloy consists of aluminum, lithium and fluorine. Carbon, oxygen, and nitrogen impurities were both below the detection limit of XPS. Grazing incidence X-ray diffraction (GIXRD) observed that LiF and (AlF<sub>3</sub>)(LiF)<sub>x</sub> alloy film have crystalline structures. Inductively coupled plasma mass spectrometry (ICP-MS) and ionic chromatography revealed atomic ratio of Li:F=1:1.1 and Al:Li:F=1:2.7: 5.4 for (AlF<sub>3</sub>)(LiF)<sub>x</sub> alloy film. These atomic ratios were consistent with the calculation from QCM experiments. Finally, lithium ion conductivity (AlF<sub>3</sub>)(LiF)<sub>x</sub> alloy film was measured as σ = 7.5 × 10<sup>-6</sup> S/cm.</div>

A DFT study of spherands containing five anisyl groups — Highly preorganized to bind the alkali metal

2006 ◽  
Vol 84 (8) ◽  
pp. 1045-1049 ◽  
Author(s):  
Shabaan AK Elroby ◽  
Kyu Hwan Lee ◽  
Seung Joo Cho ◽  
Alan Hinchliffe
Keyword(s):  
Density Functional Theory ◽  
Binding Energy ◽  
Density Functional ◽  
Ionic Radius ◽  
Binding Energies ◽  
Cavity Size ◽  
X Ray Diffraction ◽  
Functional Theory ◽  
X Ray ◽  
Good Agreement

Although anisyl units are basically poor ligands for metal ions, the rigid placements of their oxygens during synthesis rather than during complexation are undoubtedly responsible for the enhanced binding and selectivity of the spherand. We used standard B3LYP/6-31G** (5d) density functional theory (DFT) to investigate the complexation between spherands containing five anisyl groups, with CH2–O–CH2 (2) and CH2–S–CH2 (3) units in an 18-membered macrocyclic ring, and the cationic guests (Li+, Na+, and K+). Our geometric structure results for spherands 1, 2, and 3 are in good agreement with the previously reported X-ray diffraction data. The absolute values of the binding energy of all the spherands are inversely proportional to the ionic radius of the guests. The results, taken as a whole, show that replacement of one anisyl group by CH2–O–CH2 (2) and CH2–S–CH2 (3) makes the cavity bigger and less preorganized. In addition, both the binding and specificity decrease for small ions. The spherands 2 and 3 appear beautifully preorganized to bind all guests, so it is not surprising that their binding energies are close to the parent spherand 1. Interestingly, there is a clear linear relation between the radius of the cavity and the binding energy (R2 = 0.999).Key words: spherands, preorganization, density functional theory, binding energy, cavity size.

scholarly journals The influence of exocyclic lone pairs on the bonding and geometry of type A mesoionic rings

2021 ◽  
Author(s):  
Christopher Antony Ramsden ◽  
Wojciech Piotr Oziminski
Keyword(s):  
Ab Initio ◽  
Type A ◽  
Nbo Analysis ◽  
Ring Systems ◽  
X Ray ◽  
X Ray Crystallography ◽  
Bond Model ◽  
Lone Pairs ◽  
Mp2 Calculations ◽  
Good Agreement

AbstractBased on structures determined by X-ray crystallography, ab initio MP2 calculations on type A mesoionic rings give geometries in good agreement with observed values. A study of four mesoionic ring systems, each with exocyclic oxygen, nitrogen or carbon groups, shows that the presence and configuration of exocyclic lone pairs significantly influences the geometry and configurational preference. Using a localised bond model and NBO analysis, these effects are rationalised in terms of an anomeric interaction of lone pairs with the antibonding orbitals of adjacent σ bonds. In agreement with experiment, similar effects are calculated for pyran-2-imines.

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