Purpose
Ligament injuries of the ankle are among the most common injuries in the active population.Between them,
deltoid ligament injuriesoccur more often than generally believed,
with complete tears being occasionally seen in association with lateral malleolar fractures or bimalleolar fractures,
whose incidence has increased in the last decades [1].
The deltoid ligament is responsible for medial stabilization of the ankle,
limiting the anterior,
posterior and lateral translation of the talus in the talocrural joint,
with its deep bundle being the main blocker of the external rotation...
Methods and Materials
A consecutive series of patients with isolated lateral malleolar fracture admitted to the emergency room were prospectively enrolled in the period between February 10,
2016,
and November 30,
2017 (21 months).
Patients with skeletal maturity,
lateral malleolus fractures with suspicion of deltoid ligament injury ormedialmalleolar avulsion up to 5 mm,
lateral malleolus fracture with >2 mm shortening or rotational deviation were included in the study.
Those with previous trauma at the malleolar level,
isolated fracture of the medial malleolus,
posterior or without deltoid ligament injury,...
Results
In the population of 105 patients with isolated lateral malleolus fracture,
40 patients were excluded.
Of the 65 eligible patients,
40 (61.5%) were female and 25 (38.5%) were male.
The mean age was 50.7 (Max 85 and Min 14) with a standard deviation of 17.5.
Regarding laterality,
31 (47.7%) were on the right and 34 (52.3%) were on the left.
Forty-seven (72.3%) were victims of falls,
15 (23.1%) of sports accidents and 3 (4.6%) of traffic accidents.
In group I (MERS),
instability was confirmed in...
Conclusion
The Manual External Rotation Stress and the Gravity Stress test are both effective tools assessing the deltoid competence in isolated lateral malleolus fractures.
A medial clear space ≥5 mm was shown to have higher predictive value in assessing the integrity of the deltoid ligament.
There's excellentreliabilitywith reproducibility in the measurements on both tests.
In conclusion,
stress radiographs make up fundamental diagnostic elements in the therapeutic decision of isolated lateralmalleolar fractures.
References
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Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament: I.
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Stufkens SA,
Bekerom M,
Knupp M,
Hintermann,
Niek van Dijk.
The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review.
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2012; 7:73 -85
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Michalski M,
Wilson K,
Goldsmith M,
Wijdicks C,
LaPrade R,
et al..The...
Personal Information
Isabel Rosa - study author
Graduate Assistant of Orthopedics and Traumatology
Hospital de São Francisco Xavier,
Centro Hospitalar Lisboa Ocidental (CHLO),
Lisboa,
Portugal
Guest Assistant of Orthopedics -"Especialidades médicas e cirurgicas I"and doctoral student of Nova Medical School -Faculdade de Ciências Médicas de Lisboa
[email protected]
João Diogo Oliveira - presenting author
Medical resident ofRadiology
Centro Hospitalar Lisboa Ocidental (CHLO),
Lisboa,
Portugal
[email protected]
Joaquim Rodeia
Pedro Xavier Fernandes
Raquel Teixeira
Hugo Ribeiro
Medical residents of Orthopedics and Traumatology
Hospital de São Francisco Xavier,
Centro Hospitalar Lisboa...