Department of Radiology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Skeletal Radiol. 2012 Jul;41(7):787-801. doi: 10.1007/s00256-011-1284-2. Epub 2011 Oct 20.
Owing to the shortcomings of clinical examination and radiographs, injury to the syndesmotic ligaments is often misdiagnosed. When there is no indication requiring that the fractured ankle be operated on, the syndesmosis is not tested intra-operatively, and rupture of this ligamentous complex may be missed. Subsequently the patient is not treated properly leading to chronic complaints such as instability, pain, and swelling. We evaluated three fracture classification methods and radiographic measurements with respect to syndesmotic injury.
Prospectively the radiographs of 51 consecutive ankle fractures were classified according to Weber, AO-Müller, and Lauge-Hansen. Both the fracture type and additional measurements of the tibiofibular clear space (TFCS), tibiofibular overlap (TFO), medial clear space (MCS), and superior clear space (SCS) were used to assess syndesmotic injury. MRI, as standard of reference, was performed to evaluate the integrity of the distal tibiofibular syndesmosis. The sensitivity and specificity for detection of syndesmotic injury with radiography were compared to MRI.
The Weber and AO-Müller fracture classification system, in combination with additional measurements, detected syndesmotic injury with a sensitivity of 47% and a specificity of 100%, and Lauge-Hansen with both a sensitivity and a specificity of 92%. TFCS and TFO did not correlate with syndesmotic injury, and a widened MCS did not correlate with deltoid ligament injury.
Syndesmotic injury as predicted by the Lauge-Hansen fracture classification correlated well with MRI findings. With MRI the extent of syndesmotic injury and therefore fracture stage can be assessed more accurately compared to radiographs.
由于临床检查和 X 光片的局限性，下胫腓联合韧带损伤经常被误诊。当没有指征需要对骨折的踝关节进行手术时，术中不会对下胫腓联合进行测试，可能会错过这个韧带复合体的破裂。随后，患者未得到适当治疗，导致出现不稳定、疼痛和肿胀等慢性症状。我们评估了三种骨折分类方法和影像学测量方法在下胫腓联合损伤中的应用。
前瞻性地对 51 例连续踝关节骨折患者进行 Weber、AO-Müller 和 Lauge-Hansen 分类。骨折类型和胫腓骨间隙（TFCS）、胫腓骨重叠（TFO）、内侧间隙（MCS）和上间隙（SCS）的附加测量值均用于评估下胫腓联合损伤。MRI 作为标准参考，用于评估下胫腓联合的完整性。比较 X 线摄影对下胫腓联合损伤的敏感性和特异性。
Weber 和 AO-Müller 骨折分类系统结合附加测量值，对下胫腓联合损伤的敏感性为 47%，特异性为 100%，Lauge-Hansen 的敏感性和特异性均为 92%。TFCS 和 TFO 与下胫腓联合损伤不相关，MCS 增宽与三角韧带损伤不相关。
Lauge-Hansen 骨折分类预测的下胫腓联合损伤与 MRI 结果相关性良好。与 X 光片相比，MRI 可以更准确地评估下胫腓联合损伤的程度，从而确定骨折的分期。
