The use of weightbearing radiographs to assess the stability of supination-external rotation fractures of the ankle

Abstract

The use of weightbearing radiographs is an easy, pain-free, safe and reliable method to exclude the need for operative treatment, with excellent clinical outcome in the majority of the patients seen at latest follow-up. The delay of 3-10 days until the decision about surgical treatment is well accepted by the patients.

Dynamic Stress Testing Is Unnecessary for Unimalleolar Supination-External Rotation Ankle Fractures with Minimal Fracture Displacement on Lateral Radiographs

“…However, due to its moderate reliability, the MRI offers limited value to clinical decisionmaking (15). Alternatively, manual external-rotation (ER) stress radiographs (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), gravity stress tests (16)(17)(18)(19), or weight-bearing radiographs (20)(21)(22) have been used to quantify possible dynamic instability. Computer tomography (CT) has mainly been used in research settings (23,24).…”

“…There is no "gold standard" method for evaluating the stability of the ankle mortise; however, external-rotation (ER) stress radiographs have been studied most extensively (6,7,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). ER stress testing typically requires clinicians with surgical experience (19), and weight-bearing radiographs may not be possible initially, due to pain.…”

Stability-based classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury

“…since plain radiographs do not reveal dynamic incongruity, er stress or weight-bearing radiographs have been used in an attempt to demonstrate instability associated with lateral malleolar fracture and deltoid ligament injury (pankovich 1979, pankovich and shivaram 1979, Michelson et al 2001, Weber et al 2010. Gravity stress radiographs are considered to be as useful as the manual stress radiograph for determining complete deltoid ligament injury in association with an isolated distal fibular fracture (Gill et al 2007).…”

Evaluation of the Deltoid Complex in Supination External Rotation Ankle Fractures

“…If ankle joint congruity was appreciated on weight-bearing films, 90% of the patients were treated successfully with non-operative treatment. 20 Current literature suggests that a compromised deltoid ligament complex can be demonstrated in non-displaced fibula fractures by many methods. Probably the most common modality is the gravity stress radiograph because it does not require special equipment and can be rapidly performed using standardized techniques.…”