High resolution computed tomography in the chronically painful ankle sprain

Area of Science:

• Orthopedics
• Radiology
• Sports Medicine

Background:

• Chronic ankle pain is a common sequela of ankle sprains.
• Standard X-rays may not reveal subtle osseous abnormalities contributing to persistent pain.
• Identifying the source of residual pain is critical for effective patient management.

Purpose of the Study:

• To evaluate the utility of high-resolution computed tomography (CT) scanning in diagnosing the cause of chronic residual ankle pain after an ankle sprain.
• To determine the prevalence of avulsed bone fragments in patients with persistent ankle pain despite negative standard radiographs.

Main Methods:

• A consecutive series of 31 patients with chronic residual ankle pain post-ankle sprain were retrospectively analyzed.
• High-resolution CT scanning was performed on all patients.
• Surgical revision was undertaken in patients with identified avulsed fragments.

Main Results:

• High-resolution CT scanning detected avulsed intra- or juxta-articular fragments of traumatic origin in 13 out of 31 patients (42%).
• Twelve of the 13 patients with detected fragments underwent surgical revision.
• Standard X-rays were negative in these patients, highlighting the limitations of conventional imaging.

Conclusions:

• High-resolution CT scanning is a valuable tool for diagnosing chronic residual ankle pain following ankle sprain, especially when standard X-rays are inconclusive.
• Avulsed bone fragments are a significant, often occult, cause of persistent post-traumatic ankle pain.
• CT imaging can guide surgical intervention for residual ankle pain by identifying specific osseous pathologies.