Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle...

Area of Science:

• Orthopedic Surgery
• Radiology
• Sports Medicine

Background:

• Isolated distal fibular fractures from supination external rotation (SER) injuries without talar shift pose a diagnostic challenge.
• Assessing the deep deltoid ligament's integrity is crucial for determining ankle joint stability.
• These fractures can be either stable or unstable, necessitating accurate diagnostic methods.

Purpose of the Study:

• To systematically review and compare different stress radiograph modalities for assessing ankle stability.
• To evaluate diagnostic methods for SER fractures with no obvious talar subluxation on standard radiographs.

Main Methods:

• Systematic review of literature from January 2000 to January 2018.
• Searched MEDLINE, EMBASE, Ovid, Cochrane Central, CINAHL, and Google Scholar.
• Included 10 peer-reviewed articles encompassing 698 patients.

Main Results:

• Identified three main radiographic categories: external rotation (ER) stress, gravity stress views (GSV), and weightbearing (WB) radiographs.
• Weightbearing radiographs demonstrated normalization of ankle alignment in unstable cases.
• A medial clear space (MCS) greater than 4-5 mm consistently indicated an unstable ankle following SER fracture.

Conclusions:

• An MCS value below 4-5 mm is a reliable indicator of ankle stability in SER fractures, irrespective of the stress imaging modality used.
• Patients with stable fractures (MCS < 4-5 mm) can be considered for early weightbearing with favorable functional outcomes.
• Weightbearing stress radiographs are favored for assessing stability in SER ankle fractures, though based on studies with lower grades of evidence.