Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle Fractures
Background: Isolated distal fibular fractures resulting from supination external rotation (SER) injuries without evidence of obvious talar shift on standard radiographs present a diagnostic dilemma for clinicians. The status of the deep deltoid ligament, the main stabilizer of the ankle joint, is as...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2019-12-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011419890861 |
| _version_ | 1819290597885739008 |
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| author | Sohail Yousaf MBBS, MSc, FCPS(Orth), FRCS(Tr &Orth) Alan Saleh MBBS, MRCS Aashish Ahluwalia MBBS, MRCS Shahnawaz Haleem MBBS, MSc(Tr&Orth), MRCSEd, MRCSI, FRCS(Tr&Orth) Zara Hayat LLB, MBBS, MRCS Palanisamy Ramesh FRCS(TR &Orth) |
| author_facet | Sohail Yousaf MBBS, MSc, FCPS(Orth), FRCS(Tr &Orth) Alan Saleh MBBS, MRCS Aashish Ahluwalia MBBS, MRCS Shahnawaz Haleem MBBS, MSc(Tr&Orth), MRCSEd, MRCSI, FRCS(Tr&Orth) Zara Hayat LLB, MBBS, MRCS Palanisamy Ramesh FRCS(TR &Orth) |
| author_sort | Sohail Yousaf MBBS, MSc, FCPS(Orth), FRCS(Tr &Orth) |
| collection | DOAJ |
| description | Background: Isolated distal fibular fractures resulting from supination external rotation (SER) injuries without evidence of obvious talar shift on standard radiographs present a diagnostic dilemma for clinicians. The status of the deep deltoid ligament, the main stabilizer of the ankle joint, is assessed by an increase in medial clear space (MCS) on radiographs. Therefore, these injuries can be either stable or unstable. In recent years, considerable clinical and research efforts have been made to determine ankle stability following SER fracture. The purpose of this systematic review was to evaluate and compare the role of different stress radiograph modalities in assessing stability of the ankle with SER fractures with no obvious talar subluxation on standard radiographs. Methods: The electronic databases MEDLINE, EMBASE, Ovid, Cochrane Central, CINAHL, and Google Scholar were searched from January 2000 to January 2018 to identify literature relating to radiologic assessment of stability of SER ankle fractures. Results: Our literature search revealed 10 peer-reviewed articles that fulfilled inclusion criteria. This yielded a total of 698 patients. The systematic review found 3 broad categories of radiographic investigations in the assessment of ankle joint stability: external rotation (ER) stress radiographs, gravity stress views (GSV), and weightbearing (WB) radiographs. Proponents of WB radiographs have demonstrated how axial load can normalize ankle joint alignment in cases of proven instability. There was a consistently high grade of evidence for using a medial clear space (MCS) value of more than 4 to 5 mm to indicate an unstable ankle following SER fracture. Conclusion: In conclusion, the results of this systematic review support an MCS value of less than 4 to 5 mm as a good indicator of stability, regardless of choice of stress imaging modality. These patients can be allowed early weightbearing with expected good functional outcomes. Recent published literature favors WB stress radiographs as a reliable and safe technique for assessing stability in SER ankle fractures. However, it should be kept in mind that this is based on studies with relatively low grades of evidence. Level of Evidence: Level II, systematic review of variable quality studies. |
| first_indexed | 2024-12-24T03:25:17Z |
| format | Article |
| id | doaj.art-440ac02514504e90b5bf44d52f7f3215 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-12-24T03:25:17Z |
| publishDate | 2019-12-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-440ac02514504e90b5bf44d52f7f32152022-12-21T17:17:22ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142019-12-01410.1177/2473011419890861Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle FracturesSohail Yousaf MBBS, MSc, FCPS(Orth), FRCS(Tr &Orth)0Alan Saleh MBBS, MRCS1Aashish Ahluwalia MBBS, MRCS2Shahnawaz Haleem MBBS, MSc(Tr&Orth), MRCSEd, MRCSI, FRCS(Tr&Orth)3Zara Hayat LLB, MBBS, MRCS4Palanisamy Ramesh FRCS(TR &Orth)5 Epsom and St Helier University Hospitals NHS Trust, Surrey, United Kingdom Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, United Kingdom University College London Hospitals NHS Foundation Trust, London, United Kingdom St. George’s University Hospitals NHS Foundation Trust, London, United Kingdom Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, United Kingdom Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, United KingdomBackground: Isolated distal fibular fractures resulting from supination external rotation (SER) injuries without evidence of obvious talar shift on standard radiographs present a diagnostic dilemma for clinicians. The status of the deep deltoid ligament, the main stabilizer of the ankle joint, is assessed by an increase in medial clear space (MCS) on radiographs. Therefore, these injuries can be either stable or unstable. In recent years, considerable clinical and research efforts have been made to determine ankle stability following SER fracture. The purpose of this systematic review was to evaluate and compare the role of different stress radiograph modalities in assessing stability of the ankle with SER fractures with no obvious talar subluxation on standard radiographs. Methods: The electronic databases MEDLINE, EMBASE, Ovid, Cochrane Central, CINAHL, and Google Scholar were searched from January 2000 to January 2018 to identify literature relating to radiologic assessment of stability of SER ankle fractures. Results: Our literature search revealed 10 peer-reviewed articles that fulfilled inclusion criteria. This yielded a total of 698 patients. The systematic review found 3 broad categories of radiographic investigations in the assessment of ankle joint stability: external rotation (ER) stress radiographs, gravity stress views (GSV), and weightbearing (WB) radiographs. Proponents of WB radiographs have demonstrated how axial load can normalize ankle joint alignment in cases of proven instability. There was a consistently high grade of evidence for using a medial clear space (MCS) value of more than 4 to 5 mm to indicate an unstable ankle following SER fracture. Conclusion: In conclusion, the results of this systematic review support an MCS value of less than 4 to 5 mm as a good indicator of stability, regardless of choice of stress imaging modality. These patients can be allowed early weightbearing with expected good functional outcomes. Recent published literature favors WB stress radiographs as a reliable and safe technique for assessing stability in SER ankle fractures. However, it should be kept in mind that this is based on studies with relatively low grades of evidence. Level of Evidence: Level II, systematic review of variable quality studies.https://doi.org/10.1177/2473011419890861 |
| spellingShingle | Sohail Yousaf MBBS, MSc, FCPS(Orth), FRCS(Tr &Orth) Alan Saleh MBBS, MRCS Aashish Ahluwalia MBBS, MRCS Shahnawaz Haleem MBBS, MSc(Tr&Orth), MRCSEd, MRCSI, FRCS(Tr&Orth) Zara Hayat LLB, MBBS, MRCS Palanisamy Ramesh FRCS(TR &Orth) Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle Fractures Foot & Ankle Orthopaedics |
| title | Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle Fractures |
| title_full | Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle Fractures |
| title_fullStr | Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle Fractures |
| title_full_unstemmed | Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle Fractures |
| title_short | Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle Fractures |
| title_sort | systematic review of stress radiographic modalities stability assessment in supination external rotation ankle fractures |
| url | https://doi.org/10.1177/2473011419890861 |
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