Value of Ultrasound for Stability Assessment of Isolated Lateral Malleolar Fractures Compared to Stress Radiography and Arthroscopy

Abstract

Ankle fractures are commonly treated orthopedic trauma injuries. There is no doubt about surgical treatment of unstable bimalleolar or trimalleolar ankle fractures. However, treatment of isolated lateral malleolar fractures remains controversial. 1-6) The treatment strategy depends on the stability of the ankle joint. Conceptualizing the ankle joint as a ring, like the pelvis, is helpful in deciding which fractures are stable or unstable. One fracture in the otherwise intact ring is stable. 7) Therefore, pure isolated lateral malleolar fractures are stable. However, combined medial deltoid ligament injury will make the ankle unstable. The deep deltoid ligament is recognized as a primary stabilizer of the ankle. It prevents lateral talar shift and external rotation (ER) of the talus. 6) Given that the inability to maintain anatomic alignment of the mortise has been correlated with poor outcomes, the assessment of stability is critical. Ankle stability has been traditionally assessed through clinical findings and simple radiography. If medial tenderness, swelling, and ecchymosis are present on clinical examination in combination with lateral talar shift on simple radiography, a medial deltoid ligament injury is suspected. However, clinical findings alone are insufficient to determine the status of the medial deltoid ligament; other objective assessment methods are therefore needed. In clinical evaluation of lateral malleolar fractures with medial tenderness, which appear to be stable on plain radiography, stress radiography is used to determine medial deltoid injury and stability of the ankle. The me

Comparative use of ultrasound and radiography for the detection of fractures: a systematic review and narrative synthesis

“…Specificity and sensitivity for complete tears of the ligament were both 100%. The study also concludes that USG is significantly more accurate than radiography for detection of deltoid ligament injury 34 .…”

“…Generally, US has shown to superior diagnostic value in detecting isolated lateral malleolar fractures owing to its high sensitivity and specificity compared to that of conventional radiographs 34 . US has also been proposed to combined with perioperative lateral radiography in detection of complications after distal radius fractures, particularly in revealing dorsal cortex screw penetration and soft-tissue problems 36 .…”

Study on sustentaculum tali fragment constancy in intraarticular calcaneus fracture

“…6,7 An unstable joint can cause abnormal load distribution, which can lead to osteoarthritis. 5,[8][9][10] Therefore, surgeons should strive to achieve anatomic restoration and firm stabilization of the subtalar joint, which are important for optimal clinical outcomes in intraarticular calcaneal fracture. 2,8,[11][12][13] Traditionally, the sustentaculum tali (ST) fragment has been recognized as a "constant fragment."…”