Abstract:
BACKGROUND AND PURPOSE:Review the literature concerning modalities to evaluate the integrity of the deltoid ligament in patients with supination external rotation ankle fractures. METHODS:The electronic databases Pubmed/Medline, CINAHL and Embase were searched from 1987 to November 2007 to identify all published original studies concerning diagnostic modalities to evaluate the integrity of the deltoid ligament in adult ankle fractures. RESULTS:This review included nine studies involving 423 ankle fractures. Three trails investigated medial tenderness; two studies, ecchymosis; two studies, swelling; one study, an injury radiograph; six studies, a type of radiographic stress view; one study, the Lauge-Hansen classification; one study, MRI; and one article studied arthroscopy in the evaluation of the deltoid ligament integrity. INTERPRETATION:Swelling, ecchymosis, medial tenderness, initial injury radiographs and the Lauge-Hansen classification are less adequate predictors of the integrity of the deltoid ligament. Manual or the less painful variant, the gravity external rotation stress radiographs are considered the gold standard. The amount of medial clear space widening indicative of a positive external rotation stress test has been somewhat variable in the literature but > or =5 mm is generally regarded as most reliable. Achieving adequate external rotation of the foot when obtaining stress radiographs is more important than positioning the ankle in the appropriate degree of ankle flexion. The amount of applied force necessary when performing an external rotation stress radiograph is not well defined and mainly determined by the patient's pain level. The indication for surgery should not be based on the absolute value of one parameter but on the combination of several parameters. If nonoperative treatment is chosen despite a positive stress radiograph, close follow-up is critical because subluxation of the ankle joint is still possible. MRI could be useful in individual cases.
journal_name
Arch Orthop Trauma Surgjournal_title
Archives of orthopaedic and trauma surgeryauthors
van den Bekerom MP,Mutsaerts EL,van Dijk CNdoi
10.1007/s00402-008-0768-6subject
Has Abstractpub_date
2009-02-01 00:00:00pages
227-35issue
2eissn
0936-8051issn
1434-3916journal_volume
129pub_type
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journal_title:Archives of orthopaedic and trauma surgery
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journal_title:Archives of orthopaedic and trauma surgery
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journal_title:Archives of orthopaedic and trauma surgery
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journal_title:Archives of orthopaedic and trauma surgery
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journal_title:Archives of orthopaedic and trauma surgery
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更新日期:2011-05-01 00:00:00
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更新日期:2002-02-01 00:00:00
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journal_title:Archives of orthopaedic and trauma surgery
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journal_title:Archives of orthopaedic and trauma surgery
pub_type: 杂志文章
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更新日期:1994-01-01 00:00:00
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journal_title:Archives of orthopaedic and trauma surgery
pub_type: 杂志文章
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更新日期:1995-01-01 00:00:00
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更新日期:2008-02-01 00:00:00
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更新日期:2018-07-01 00:00:00
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pub_type: 杂志文章,评审
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pub_type: 杂志文章,meta分析
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更新日期:2015-01-01 00:00:00
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更新日期:2011-10-01 00:00:00
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更新日期:2011-05-01 00:00:00
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pub_type: 杂志文章,评审
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journal_title:Archives of orthopaedic and trauma surgery
pub_type: 杂志文章
doi:10.1007/s004020050381
更新日期:1999-01-01 00:00:00
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更新日期:2011-01-01 00:00:00