Comparison of Manual and Gravity Stress Radiographs for the Evaluation of Supination-External Rotation Fibular Fractures

Abstract

The gravity stress radiograph is equivalent to the manual stress radiograph for determining deltoid ligament injury in association with an isolated distal fibular fracture, and thus it can be used to determine ankle stability in patients who present with an isolated distal fibular fracture.

Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature

“…An overview is shown in Tables 1 and 2. Three trails investigated medial tenderness [12,16,29]; two studies, ecchymosis [16,29]; two studies, swelling [16,29]; one study, an injury radiograph [46]; six studies, a type of radiographic stress view [12,16,18,29,32,35,45]; one study, the Lauge-Hansen classiWcation [46]; one study, MRI [24]; and one article studied arthroscopy [46] in the evaluation of the deltoid ligament integrity. The publication dates span 6 years; in 2001, Michelson et al [32] was the earliest and in 2007, Koval et al [24] and Schock et al [45] were the most recent publications.…”

“…Tornetta stated that these tests are the gold standard of subluxation, an indirect measurement of deltoid injury or deltoid insuYciency. The amount of medial clear space widening indicative of a positive external rotation stress or gravity-stress test has been somewhat variable in the literature [8,12,16,18,19,21,23,28,29,32,35,40,46]. Normal values reported in the literature have varied from 1 to 5 mm [8,11,19,21,28].…”

“…Normal values reported in the literature have varied from 1 to 5 mm [8,11,19,21,28]. A medial clear space of ¸4 mm, with that value being at least 1 mm greater than the superior tibiotalar space is a value that is accepted to represent an unstable ankle fracture [2,16,18,20,29,30,40]. A recent cadaver study examining the position of the ankle at the time of stress radiography demonstrated that a medial clear space of 5 mm was a reliable predictor of deltoid ligament incompetence [35].…”

“…McConnell et al [29] Soft-tissue indicators are not accurate predictors of instability Gill et al [18] Manual is equivalent to gravity-stress radiographs Egol et al [16] Medial tenderness, swelling, and ecchymosis were not sensitive in predicting instability…”

Evaluation of the Deltoid Complex in Supination External Rotation Ankle Fractures

“…9,10 Evaluation of the medial clear space (MCS) in these bimalleolar equivalent injuries on stress radiographs has shown that American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey scores decline with an increase in MCS 11 when treated conservatively.…”