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Incidence of Nonindicated and Inadequate Ankle Stress Views
Pooria Hosseini1, David E Teytelbaum1, Arjun Vohra2
1Saint Louis University School of Medicine, St. Louis, Missouri.
Journal of Surgical Orthopaedic Advances
|June 12, 2026
Summary
Ankle stress view (ASV) radiographs are often not indicated or are of poor quality for ankle fractures. Improving ASV use is crucial for appropriate surgical decision-making in fracture care.
Area of Science:
- Orthopaedic Surgery
- Radiology
- Trauma Care
Background:
- Ankle stress view (ASV) radiographs and medial clear space (MCS) measurements are vital for operative fixation decisions in ankle fractures.
- Variability in ASV indications and radiograph quality requires investigation.
Purpose of the Study:
- To evaluate the appropriate indications and quality of ASV radiographs in ankle fracture patients.
- To assess the impact of ASV quality and indication on surgical management.
Main Methods:
- Retrospective case series of 130 ankle fracture patients (2012-2019).
- ASV indications defined for Weber B fractures with MCS < 4 mm on mortise views.
- Analysis of patient demographics, ASV indications, radiograph adequacy, and operative management.
Main Results:
- 27% of ASV radiographs were not indicated, and 30% were of inadequate quality.
- 60% of patients with inadequate ASVs underwent surgery.
- Only 51% of ASV radiographs met both appropriate indication and adequate quality criteria.
Conclusions:
- Significant variability exists in the appropriate use and quality of ASV radiographs for ankle fractures.
- Inadequate ASVs may influence surgical decisions, highlighting the need for improved standardization and quality control.
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