title: 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.
authors.affiliation: Department of Trauma and Orthopedics, Adelaide and Meath Hospital, Dublin, Ireland. shwanhenari@hotmail.com
authors.forename: Shwan
authors.initials: S
authors.lastname: Henari
authors.forename: Louisa N
authors.initials: LN
authors.lastname: Banks
authors.forename: Ingrid
authors.initials: I
authors.lastname: Radovanovic
authors.forename: Ingrid
authors.initials: I
authors.lastname: Radiovanovic
authors.forename: Joseph
authors.initials: J
authors.lastname: Queally
authors.forename: Seamus
authors.initials: S
authors.lastname: Morris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000843:Ankle Joint / Q000503:physiopathology; D005260:Female; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008023:Ligaments, Articular / Q000293:injuries* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012399:Rotation; D012421:Rupture; D013484:Supination / Q000502:physiology*; D013977:Tibia / Q000601:surgery; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult