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Does medial tenderness predict deep deltoid ligament incompetence in supination-external rotation type ankle fractures
UMass Chan Affiliations
Department of Orthopedics and Physical RehabilitationDocument Type
Journal ArticlePublication Date
2007-04-07Keywords
AdolescentAdult
Aged
Ankle Injuries
Female
Follow-Up Studies
Humans
Ligaments, Articular
Male
Middle Aged
Prognosis
Range of Motion, Articular
Supination
Trauma Severity Indices
Orthopedics
Rehabilitation and Therapy
Metadata
Show full item recordAbstract
OBJECTIVE: To identify whether medial tenderness is a predictor of deep deltoid ligament incompetence in supination-external rotation ankle fractures. DESIGN: All Weber B lateral malleolar fractures with normal medial clear space over a 9 month period were prospectively included in the study. Fracture patterns not consistent with a supination-external rotation mechanism were excluded. SETTING: High-volume tertiary care referral center and Level I trauma center. PATIENTS/PARTICIPANTS: Fifty-five skeletally mature patients with a Weber B lateral malleolar fracture and normal medial clear space presenting to our institution were included. INTERVENTION: All study patients had ankle anteroposterior, lateral, and mortise radiographs. Each patient was seen and evaluated by an orthopedic specialist and the mechanism of injury was recorded. Each patient was assessed for tenderness to palpation in the region of the deltoid ligament and then had an external rotation stress mortise radiograph. MAIN OUTCOME MEASURE: Correlating medial tenderness with deep deltoid competence as measured by stress radiographs. RESULTS: Thirteen patients (23.6%) were tender medially and had a positive external rotation stress radiograph. Thirteen patients (23.6%) were tender medially and had a negative external rotation stress radiograph. Nineteen patients (34.5%) were nontender medially and had a negative external rotation stress radiograph. Ten patients (18.2%) were nontender medially and had a positive external rotation stress radiograph. We calculated a chi statistic of 2.37 as well as the associated P value of 0.12. Medial tenderness as a measure of deep deltoid ligament incompetence had a sensitivity of 57%, a specificity of 59%, a positive predictive value of 50%, a negative predictive value of 66%, and an accuracy of 42%. CONCLUSION: There was no statistical significance between the presence of medial tenderness and deep deltoid ligament incompetence. There is a 25% chance of the fracture in question with medial tenderness having a positive external rotation stress and a 25% chance the fracture with no medial tenderness having a positive stress test. Medial tenderness in a Weber B lateral ankle fracture with a normal clear space on standard plain radiographs does not ensure the presence of a positive external rotation stress test.Source
J Orthop Trauma. 2007 Apr;21(4):244-7. Link to article on publisher's siteDOI
10.1097/BOT.0b013e3180413835Permanent Link to this Item
http://hdl.handle.net/20.500.14038/43053PubMed ID
17414551Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1097/BOT.0b013e3180413835