The additional value of an oblique image plane for MRI of the anterior and posterior distal tibiofibular syndesmosis

Hermans, John J.; Ginai, Abida Z.; Wentink, N.; Hop, Wim C. J.; Beumer, Annechien

doi:10.1007/s00256-010-0938-9

Cited by 37 publications

(21 citation statements)

References 28 publications

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“…A ski-boot type coil was used to stabilise the foot. Images were acquired in the axial, coronal, sagittal and oblique planes with the foot in neutral position as reported by Hermans et al 34 All MRIs were read and reported on by a single radiologist with 16 years of experience in musculoskeletal imaging (JL). Continuity of the ankle syndesmosis ligament fibres as well as syndesmosis alignment was assessed.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic accuracy of clinical tests for ankle syndesmosis injury

et al. 2013

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Objective Our aim was to investigate the diagnostic accuracy of the clinical presentation of ankle syndesmosis injury and four common clinical diagnostic tests. Design Cross-sectional diagnostic accuracy study. Setting 9 clinics in two Australian cities. Participants 87 participants (78% male) with an ankle sprain injury presenting to participating clinics within 2 weeks of injury were enrolled. Methods Clinical presentation, dorsiflexion-external rotation stress test, dorsiflexion lunge with compression test, squeeze test and ankle syndesmosis ligament palpation were compared with MRI results (read by a blinded radiologist) as a reference standard. Tests were evaluated using diagnostic accuracy, sensitivity, specificity and likelihood ratios (LRs). A backwards stepwise Cox regression model determined the combined value of the clinical tests. Results The clinical presentation of an inability to perform a single leg hop had the highest sensitivity (89%) with a negative LR of 0.37 (95% CI 0.13 to 1.03). Specificity was highest for pain out of proportion to the apparent injury (79%) with a positive LR of 3.05(95% CI 1.68 to 5.55). Of the clinical tests, the squeeze test had the highest specificity (88%) with a positive LR of 2.15 (95% CI 0.86 to 5.39). Syndesmosis ligament tenderness (92%) and the dorsiflexion-external rotation stress test (71%) had the highest sensitivity values and negative LR of 0.28 (95% CI 0.09 to 0.89) and 0.46 (95% CI 0.27 to 0.79), respectively. Syndesmosis injury was four times more likely to be present with positive syndesmosis ligament tenderness (OR 4.04, p=0.048) or a positive dorsiflexion/external rotation stress test (OR 3.9, p=0.004). Conclusions Although no single test is sufficiently accurate for diagnosis, we recommend a combination of sensitive and specific signs, symptoms and tests to confirm ankle syndesmosis involvement. An inability to hop, syndesmosis ligament tenderness and the dorsiflexion-external rotation stress test (sensitive) may be combined with pain out of proportion to injury and the squeeze test (specific).

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Section: Methodsmentioning

confidence: 99%

Diagnostic accuracy of clinical tests for ankle syndesmosis injury

et al. 2013

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“…As the ATIFL runs obliquely, MR images in an axial plane could lead to depiction of a partly interrupted ligament, leading to a false positive diagnosis of a ruptured ligament. Using an additional oblique image plane of about 45° reduces this problem (Hermans et al. 2010).…”

Section: The Syndesmotic Ligamentsmentioning

confidence: 99%

Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach

et al. 2010

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A syndesmosis is defined as a fibrous joint in which two adjacent bones are linked by a strong membrane or ligaments. This definition also applies for the distal tibiofibular syndesmosis, which is a syndesmotic joint formed by two bones and four ligaments. The distal tibia and fibula form the osseous part of the syndesmosis and are linked by the distal anterior tibiofibular ligament, the distal posterior tibiofibular ligament, the transverse ligament and the interosseous ligament. Although the syndesmosis is a joint, in the literature the term syndesmotic injury is used to describe injury of the syndesmotic ligaments. In an estimated 1-11% of all ankle sprains, injury of the distal tibiofibular syndesmosis occurs. Forty percent of patients still have complaints of ankle instability 6 months after an ankle sprain. This could be due to widening of the ankle mortise as a result of increased length of the syndesmotic ligaments after acute ankle sprain. As widening of the ankle mortise by 1 mm decreases the contact area of the tibiotalar joint by 42%, this could lead to instability and hence early osteoarthritis of the tibiotalar joint. In fractures of the ankle, syndesmotic injury occurs in about 50% of type Weber B and in all of type Weber C fractures. However, in discussing syndesmotic injury, it seems the exact proximal and distal boundaries of the distal tibiofibular syndesmosis are not well defined. There is no clear statement in the Ashhurst and Bromer etiological, the LaugeHansen genetic or the Danis-Weber topographical fracture classification about the exact extent of the syndesmosis. This joint is also not clearly defined in anatomical textbooks, such as Lanz and Wachsmuth. Kelikian and Kelikian postulate that the distal tibiofibular joint begins at the level of origin of the tibiofibular ligaments from the tibia and ends where these ligaments insert into the fibular malleolus. As the syndesmosis of the ankle plays an important role in the stability of the talocrural joint, understanding of the exact anatomy of both the osseous and ligamentous structures is essential in interpreting plain radiographs, CT and MR images, in ankle arthroscopy and in therapeutic management. With this pictorial essay we try to fill the hiatus in anatomic knowledge and provide a detailed anatomic description of the syndesmotic bones with the incisura fibularis, the syndesmotic recess, synovial fold and tibiofibular contact zone and the four syndesmotic ligaments. Each section describes a separate syndesmotic structure, followed by its clinical relevance and discussion of remaining questions.

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“…In humans, S. aureus is a well-documented opportunistic pathogen. It may cause food poisoning, pneumonia, skin infections, enterotoxemia, and septicemic infections; furthermore, it is important as the cause of toxic shock syndrome (TSS) ( 1 , 3 ). S. aureus causes severe animal diseases such as mastitis, suppurative disease, arthritis, and urinary tract infections ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Enterotoxigenic Staphylococcus aureus Isolated From Chicken Nugget in Iran

Madahi

Rostami

Rahimi

et al. 2014

Jundishapur J Microbiol

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Background:The enterotoxigenic Staphylococcus aureus is considered as one of the most important cause of food poisoning that manifests with gastroenteritis, diarrhea, and vomiting. Its complications usually occur when bacterial virulence genes are produced. The most important virulence factors are cell-associated components, exoenzymes, exotoxins, enterotoxins, and enterotoxin-like toxins.Objectives:The present study aimed to study the presence of S. aureus and its virulence factors in chicken nuggets in Iran.Materials and Methods:Totally, 420 chicken nuggets from five brands were collected from Isfahan and Chaharmahal-va-Bakhtiari provinces, Iran. Samples were cultured and the positive results were studied using ELISA and PCR for detection of classical staphylococcal enterotoxins and sea-sej virulence genes, respectively.Results:Results showed that 27 (6.42%) of 420 samples were contaminated with S. aureus with bacteria concentration between 6.1 × 103 to 8.4 × 101/mL. Totally, 33.33% of isolates produced SEA, 4.16% SEB, 12.50% SEC, 8.33% SED, 12.50% SEA + SEC, and 12.50% SEA + SED. The most commonly detected genes were sea (25%), sea + seg (8.33%), sec (12.50%), sea + sed (12.50%), and sea + sec + sej (12.50%).Conclusions:S. aureus can easily contaminate the chicken nugget and this contamination is usually associated with significant presences of virulence genes. Consumption of these nuggets certainly is associated with gastrointestinal diseases. Therefore, some food safety and quality standards should be applied and performed in most of the Iranian food units to control growth of S. aureus and its virulence factors.

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The additional value of an oblique image plane for MRI of the anterior and posterior distal tibiofibular syndesmosis

Cited by 37 publications

References 28 publications

Diagnostic accuracy of clinical tests for ankle syndesmosis injury

Diagnostic accuracy of clinical tests for ankle syndesmosis injury

Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach

Prevalence of Enterotoxigenic Staphylococcus aureus Isolated From Chicken Nugget in Iran

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