Prospective evaluation of history and physical examination: variables to determine radiography in acute ankle injuries.
OBJECTIVE
This study investigated history and physical findings among 74 patients with acute ankle injuries in order to determine factors significantly associated with fractures, excluding avulsion fragments < 3 mm in size, and syndesmosis injuries and to determine factors that necessitate radiography.


METHODS
This was a prospective study performed during a 12-month period. After recording history and physical examination data, a gestalt prediction of a positive or negative radiographic result was made before the patient underwent ankle radiography. Analysis then determined factors important for radiography.


METHODS
Patients who presented to a sports medicine center with an acute ankle injury were enrolled in the study after meeting the enrollment criteria.


METHODS
Before analysis, predictions for injury were based on accepted indicators. Outcome measures, factors that would indicate the need for radiography, were formulated after data collection and statistical analysis.


RESULTS
Radiographic findings showed nine fractures and three widened syndesmoses as well as 15 minor ligamentous avulsions. Statistical analysis showed significant association (p < 0.05) of fracture with previous ankle fracture, syndesmosis pain with external rotation stress testing, and pain along the middle third of the distal fibula, from anterior to posterior. Syndesmosis injuries had a significant association with pain during external rotation stress testing.


CONCLUSIONS
Although additional investigation with larger patient numbers would be beneficial, this study highlights the importance of history of previous fracture, pain on the distal mid-fibula or mid-tibia, and pain with external rotation. Furthermore, if these three variables are prospectively applied as criteria for radiography, a 55% reduction in radiography would result with 100% sensitivity. Finally, experienced sports medicine physicians had a 100% sensitivity, 68% specificity, 100% negative predictive value, and 39% positive predictive value for prediction of clinically significant fractures or syndesmosis injuries.
Vanderbilt Sports Medicine Center, Nashville, Tennessee 37212, USA.
P R
PR
Stricker
K P
KP
Spindler
K B
KB
Gautier
D000208:Acute Disease; D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D011446:Prospective Studies; D011859:Radiography