Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.
Clin Orthop Surg. 2020 Dec;12(4):535-541. doi: 10.4055/cios20020. Epub 2020 Nov 18.
This study was performed to evaluate the value of using ultrasound for stability assessment of isolated lateral malleolar fractures compared to simple X-ray, stress radiography, and arthroscopy.
This is a prospective cohort study with 25 consecutive patients who underwent an arthroscopic examination and subsequent surgery for isolated lateral malleolar ankle fractures. Before operation, simple and external rotation stress radiographs were obtained. Ultrasound was performed to assess the medial deltoid ligament prior to operation. Arthroscopic findings were used as reference standards. Sensitivity, specificity, and positive and negative predictability were calculated and compared using receiver operating characteristic (ROC) curve analysis for simple radiography, stress radiography, and ultrasound examination.
The sensitivity and specificity of ultrasound for tears of the deep deltoid ligament were 94.74% and 66.67%, respectively. But, they were both 100% for complete tears of the ligament. ROC curve analysis showed that the ultrasound examination was significantly more accurate than simple and stress radiography.
Ultrasound could be used to assess the instability of isolated lateral malleolar fractures. Commonly used stress radiography appears to overrate the need for operative treatment.
本研究旨在评估与单纯 X 线、应变成像和关节镜相比，超声在评估孤立外踝骨折稳定性方面的价值。
这是一项前瞻性队列研究，共纳入 25 例连续接受关节镜检查和后续手术治疗的孤立外踝骨折患者。术前均行常规和外旋应变成像，术前还进行了超声检查以评估内侧三角韧带。以关节镜检查结果作为参考标准。使用受试者工作特征（ROC）曲线分析比较单纯 X 线、应变成像和超声检查的敏感性、特异性、阳性预测值和阴性预测值。
超声检查对于深三角韧带撕裂的敏感性和特异性分别为 94.74%和 66.67%，但对于完全撕裂的韧带均为 100%。ROC 曲线分析显示，超声检查明显比单纯 X 线和应变成像更准确。
超声可用于评估孤立外踝骨折的不稳定性。常用的应变成像似乎高估了手术治疗的必要性。
