Incidence and clinical significance of bone bruises after supination injury of the ankle

Abstract

W e used MRI to study a prospective series of 95 patients with inversion injuries of the ankle and no fracture on plain radiographs. We found an incidence of bone bruises of 27%, but these made no difference to the time of return to work, limitation of walking or physical activity, or the clinical outcome scores at three months.We conclude that bone bruises have very little clinical significance after inversion injuries of the ankle.J Bone Joint Surg [Br] 1998;80-B:513-5. Received 26 September 1997; Accepted after revision 22 December 1997 It has been estimated that regardless of treatment about 30% of patients with injuries of the ankle ligaments have residual symptoms such as pain and swelling or a sense of instability. 1 The reasons for such an outcome are still not understood, although one possible factor is injury to the bones of the ankle. Anderson et al 2 found that of 30 patients with residual symptoms 57% had an osteochondral fracture of the dome of the talus which was visible on MRI but not on conventional radiographs. MRI can detect subtle injuries of cartilage and osteochondral bone. [3][4][5][6] Damage to cartilage may lead to a lesion of subchondral bone seen as a bone bruise on MRI. 7 The articular cartilage may appear to be intact 8 and such lesions may represent elastic deformation of the cartilage with haemorrhage and disruption of the trabecular bone. 9 Moreover, these subchondral microfractures may progress to osteochondral defects after several months. 8Our aim was to determine the incidence and clinical significance of bone bruises in supination injuries of the ankle. Patients and MethodsBetween May 1995 and December 1996, we asked patients with ankle sprains and no fracture visible on standard radiographs, or with no history of a sprain in either ankle to volunteer for our study. We set an age range of 15 to 60 years and excluded patients with alcoholism or rheumatoid arthritis. The participation rate among those with their first injury was 80%, but we found that most patients treated in our casualty department had had an earlier inversion injury which excluded them from our study. There were 95 consecutive volunteers, 48 men and 47 women, with a mean age of 28 years (SD 9; 15 to 56).The mechanism of the ankle injury was a combination of inversion and plantar flexion. In 12 the injury had occurred at work, in 40 at sport and in 43 at other leisure activities. The left and right feet were equally involved. A subcutaneous haematoma was present in 59 of the patients (62%). There was no swelling in 11 (11%), lateral swelling in 74 (78%) and widespread swelling in 10 ankles. Twenty-six patients were unable to bear weight on the injured foot. Imaging methods. Conventional radiographs were used to exclude fractures. For MRI we used a 0.23 T open-configurated device (Outlook; Picker-Nordstar Inc, Helsinki, Finland) and a circumferential surface coil. To avoid inadvertent movement, the leg was held in a vacuum cast. We used T1-weighted spin-echo (SE) images for the first 21 patients and T2-weig...

Ultasound guided management of ankle sprain

“…15,16 Mean age is 33years (18-64) in our study and right ankle being more commonly involved (71%) as it is dominant which is comparable to other studies. 3,[12][13][14][15] Anatomically sprains of the ankle can be divided into the lateral ligament, medial ligament and syndesmotic sprains of which the lateral ligament sprain induced by an inversion injury, which takes up 85% of ankle sprains, is the most common.…”

Arthroscopic Assessment for Intra-articular Disorders in Residual Ankle Disability after Sprain

“…Several authors have reported the usefulness of MRI for diagnosing lateral ligament injuries, ¶ tibiofibular ligament injuries, 32,35,52 calcaneocuboid ligament injuries, 2 sinus tarsi syndrome, 24 tarsal tunnel syndrome, 16 peroneal tendon injury, 3,46 superficial peroneal nerve entrapment, 8 osteochondral lesions, 14 and osseous lesions including bone bruises. 1,23,40 However, MRI is not always more accurate than arthroscopy, especially in the diagnosis of tibiofibular ligament disruption or osteochondral lesions. 33,49 In the present study, advanced cases of grade III or IV lesions could be detected by preoperative MRI.…”

Rehabilitation of Lateral Ankle Sprains in Sports

“…In the course of the inversion, the body's center of gravity moves over the ankle leading to ankle sprains [2]. There are three clinical grades of lateral ankle sprains [4][5][6].…”

“…Even mild exacerbations lead to short-term dysfunction. It is characterized by residual ankle instability as a result of either mechanical ankle stability or functional ankle instability or a combination of both [6].…”