Gill J Brian, Risko Timothy, Raducan Viorel, Grimes J Speight, Schutt Robert C
Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences, 3601 4th Street, Lubbock, TX 79430, USA.
J Bone Joint Surg Am. 2007 May;89(5):994-9. doi: 10.2106/JBJS.F.01002.
Isolated distal fibular fractures most commonly result from a supination-external rotation injury of the ankle. Deltoid ligament ruptures can also be associated with these injuries, resulting in an unstable ankle fracture due to incompetent lateral and medial restraints. We hypothesized that a gravity stress radiograph is equivalent to a manual stress radiograph for the detection of deltoid ligament injury in association with an isolated fibular fracture.
All patients presenting to a level-1 trauma hospital emergency department with an isolated fibular fracture were screened. Ankle stability was determined on the basis of radiographic measurements of the medial clear space and talar shift. A manual stress radiograph and a gravity stress radiograph of the injured ankle were made for each patient. The manual stress radiograph was used to determine whether the ankle was stable or unstable.
A total of twenty-five patients (thirteen with a supination-external rotation type-II fracture and twelve with a supination-external rotation type-IV-equivalent injury) were enrolled in the study. In the type-II group, the average medial clear space was 4.15 and 4.26 mm on the manual and gravity stress radiographs, respectively (p = 0.50). In the type-IV group, the average medial clear space was 5.21 and 5.00 mm on the manual and gravity stress radiographs, respectively (p = 0.69).
The gravity stress radiograph is equivalent to the manual stress radiograph for determining deltoid ligament injury in association with an isolated distal fibular fracture, and thus it can be used to determine ankle stability in patients who present with an isolated distal fibular fracture.
单纯腓骨远端骨折最常见于踝关节旋后-外旋损伤。三角韧带断裂也可能与这些损伤相关，由于外侧和内侧约束功能不全导致踝关节骨折不稳定。我们假设重力应力位X线片在检测与单纯腓骨骨折相关的三角韧带损伤方面等同于手法应力位X线片。
对所有就诊于一级创伤医院急诊科的单纯腓骨骨折患者进行筛查。根据内侧间隙和距骨移位的X线测量结果确定踝关节稳定性。为每位患者拍摄受伤踝关节的手法应力位X线片和重力应力位X线片。手法应力位X线片用于确定踝关节是否稳定。
共有25例患者（13例旋后-外旋II型骨折和12例旋后-外旋IV型等效损伤）纳入研究。在II型组中，手法应力位X线片和重力应力位X线片上的平均内侧间隙分别为4.15和4.26mm（p = 0.50）。在IV型组中，手法应力位X线片和重力应力位X线片上的平均内侧间隙分别为5.21和5.00mm（p = 0.69）。
重力应力位X线片在确定与单纯腓骨远端骨折相关的三角韧带损伤方面等同于手法应力位X线片，因此可用于确定单纯腓骨远端骨折患者的踝关节稳定性。
