Antoci Valentin, Patel Shaun P, Weaver Michael J, Kwon John Y
Department of Orthopaedic Surgery, Brown University, Providence, RI, United States.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States.
Injury. 2016 Oct;47(10):2366-2369. doi: 10.1016/j.injury.2016.07.025. Epub 2016 Jul 20.
Routinely obtaining adjacent joint radiographs when evaluating patients with ankle fractures may be of limited clinical utility and an unnecessary burden, particularly in the absence of clinical suspicion for concomitant injuries.
One thousand, three hundred and seventy patients who sustained ankle fractures over a 5-year period presenting to two level 1 trauma centers were identified. Medical records were retrospectively reviewed for demographics, physical examination findings, and radiographic information. Analyses included descriptive statistics along with sensitivity and predictive value calculations for the presence of adjacent joint fracture.
Adjacent joint imaging (n=1045 radiographs) of either the knee or foot was obtained in 873 patients (63.7%). Of those, 75/761 patients (9.9%) demonstrated additional fractures proximal to the ankle joint, most commonly of the proximal fibula. Twenty-two of 284 (7.7%) demonstrated additional fractures distal to the ankle joint, most commonly of the metatarsals. Tenderness to palpation demonstrated sensitivities of 0.92 and 0.77 and positive predictive values of 0.94 and 0.89 for the presence of proximal and distal fractures, respectively. Additionally, 19/22 (86.4%) of patients sustaining foot fractures had their injury detectable on initial ankle X-rays. Overall, only 5.5% (75/1370) of patients sustained fractures proximal to the ankle and only 0.2% (3/1370) of patients had additional foot fractures not evident on initial ankle X-rays.
The addition of adjacent joint imaging for the evaluation of patients sustaining ankle fractures is low yield. As such, patient history, physical examination, and clinical suspicion should direct the need for additional X-rays.
Level IV.
在评估踝关节骨折患者时常规获取相邻关节的X线片，其临床效用可能有限且是不必要的负担，尤其是在没有临床怀疑合并损伤的情况下。
确定了在5年期间前往两个一级创伤中心就诊的1370例踝关节骨折患者。对病历进行回顾性分析，以获取人口统计学、体格检查结果和影像学信息。分析包括描述性统计以及相邻关节骨折存在情况的敏感性和预测值计算。
873例患者（63.7%）进行了膝关节或足部的相邻关节成像（共1045张X线片）。其中，761例患者中有75例（9.9%）在踝关节近端出现额外骨折，最常见的是腓骨近端骨折。284例患者中有22例（7.7%）在踝关节远端出现额外骨折，最常见的是跖骨骨折。触诊压痛对近端和远端骨折存在情况的敏感性分别为0.92和0.77，阳性预测值分别为0.94和0.89。此外，22例足部骨折患者中有19例（86.4%）在最初的踝关节X线片上可检测到损伤。总体而言，仅5.5%（75/1370）的患者在踝关节近端发生骨折，仅0.2%（3/1370）的患者在最初的踝关节X线片上不明显的额外足部骨折。
在评估踝关节骨折患者时增加相邻关节成像的检出率较低。因此，患者病史、体格检查和临床怀疑应指导是否需要额外的X线检查。
四级。
