title: Gravity versus manual external rotation stress view in evaluating ankle stability: a prospective study.
abstract: BACKGROUND
  The purpose of this prospective study was to determine whether gravity versus manual external rotation stress testing effectively detects widening of the medial clear space in isolated ankle fractures when compared with the uninjured contralateral side.
  
  
  METHODS
  Manual external rotation stress and gravity stress tests were performed on injured and uninjured ankles of ankle fracture patients in a clinic setting. Medial clear space measurements were recorded and differences between gravity and manual stress views were determined.
  
  
  RESULTS
  Twenty consecutive patients with ankle injury were enrolled in the study. When compared with the uninjured side, gravity stress views showed a statistically significant (P = .017) increase in medial clear space widening (1.85 ± 1.07 mm) compared with manual stress view widening (1.35 ± 1.04 mm).
  
  
  CONCLUSIONS
  This study suggests that gravity stress views are as effective as manual external rotation stress views in detecting medial clear space widening in isolated fibular fractures.
  
  
  METHODS
  Diagnostic, Level II: Prospective, comparative trial.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Thu-Ba
authors.initials: TB
authors.lastname: LeBa
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas zgugala@utmb.edu.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gugala
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Randal P
authors.initials: RP
authors.lastname: Morris
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Panchbhavi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000175:diagnosis* / Q000503:physiopathology; D000843:Ankle Joint / Q000503:physiopathology*; D005260:Female; D006112:Gravitation; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012399:Rotation; D013314:Stress, Mechanical; D013484:Supination / Q000502:physiology*; D055815:Young Adult
keywords: ankle fracture; ankle stability stress test; radiography; supination external rotation injury