Ultrasonography as a Diagnostic Tool in Assessing Deltoid Ligament Injury in Supination External Rotation Fractures of the Ankle

Abstract

The medial deltoid ligament is the primary stabilizing structure in the ankle joint following lateral malleolar fracture. However, medial deltoid ligament ruptures are difficult to diagnose using current imaging modalities. We hypothesized that ultrasonography can be used to accurately allow early clinical assessment of ankle fracture stability, thereby negating the need to perform plain film stress views of the acutely injured ankle. This prospective study included 12 patients (age range, 18-72) with supination external rotation fractures requiring operative fixation. Following induction of anesthesia, ultrasonography examination was performed, followed by an arthrogram under fluoroscopic screening. Radiographs, ultrasonography, and arthrographic findings were compared. There was 100% correlation between ultrasonography and arthrogram findings. Ultrasonography accurately diagnosed medial deltoid rupture with a sensitivity of 100% and specificity of 100%. Plain film radiographs of the ankle had a sensitivity of 57.1% and a specificity of 60%. The difference between these was significant (χ(2)=.0091). This study demonstrates diagnostic ultrasonography to be an accurate diagnostic modality in assessing medial deltoid ligament integrity in patients with supination external rotation fractures. It offers the same sensitivity and specificity as arthrography without the need for additional invasive procedures. Its relative ease of use and lack of ionizing radiation make it a potentially useful tool, particularly in a busy trauma service.

Syndesmosis and deltoid ligament injuries in the athlete

“…Ultrasound has greater diagnostic ability with a 100 % sensitivity and specificity in this study [36]. Other views should be guided by the clinical examination, such as high fibular pain.…”

Normal and Injured Ankle Ligaments on Ultrasonography With Magnetic Resonance Imaging Correlation

“…In the setting of Weber type B and C fractures, US was found to have 100% sensitivity for the detection of complete rupture of the deltoid ligament but only sensitivity of 50% for partial ruptures; thus, it may be helpful but not entirely replace MRI for the assessment of medial instability in this clinical setting . Another study demonstrated 100% sensitivity and specificity of US for medial deltoid rupture with a 100% correlation between US and arthroscopy in supination external rotation fractures of the ankle, thus possibly obviating the need for stress radiographs …”

“…23 Another study demonstrated 100% sensitivity and specificity of US for medial deltoid rupture with a 100% correlation between US and arthroscopy in supination external rotation fractures of the ankle, thus possibly obviating the need for stress radiographs. 24…”

Akutdiagnostik von Sportverletzungen

“…So kann z. B. bei der Distorsion des oberen Sprunggelenks, welche mit 5% eine der häufigs-ten Verletzungen in der chirurgischen Notaufnahme darstellt [15], die Ruptur des medialen [6] und lateralen Kollateralbandapparats [11,13] …”