Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA.
J Orthop Trauma. 2022 Jan 1;36(1):e1-e5. doi: 10.1097/BOT.0000000000002139.
To evaluate and compare radiographic findings in supination external (SE)2 injuries versus stress (+) SE4 injuries.
Retrospective.
Academic Level 1 trauma center.
The study included 350 skeletally mature patients at a single Level 1 trauma center who presented with an isolated, Lauge-Hansen type supination-external rotation pattern, Weber B lateral malleolar fracture, OTA/AO 44-B.
We reviewed 350 patients (185 men and 165 women), 18-95 years of age (avg 45), with isolated SE pattern lateral malleolar fractures. One hundred nine had SE4 injuries [medial clear space (MCS) = 8.3 mm]. Two hundred forty-one ankles were stressed; 164 were unstable and 77 were stable (SE2). Avg MCS at presentation and on stress radiographs was 3.59 mm for the SE2 (no widening) and 3.86 mm and 5.94 mm for the stress (+) SE4 group, respectively. The fibular displacement for the SE2, stress (+) SE4, and SE4 groups was 1.5 (0-4.5), 3.5 (0-6.6), and 4.1 (0-30.5), respectively. Sixteen of the 77 (20%) SE2 and 24 of the 164 (15%) stress (+) SE4 fractures had no displacement of the fibula on the lateral view. Similarly, 53 of the 77 (68%) SE2 and 91 of the 164 (55%) stress (+) SE4 had ≤2 mm of fibular displacement Fibular displacement of ≤2 mm on the lateral radiograph corresponded with 0.69 sensitivity and only 0.37 positive predictive value for stable ankle mortise on stress examination.
Previous work indicated that patients with an isolated SE pattern fibula fracture, a normal MCS, and ≤2 mm of fibular displacement on the lateral radiograph have a high rate of ankle stability, with a positive predictive value of approximately 97%. We were unable to confirm this finding because 15% of unstable ankles had 0 mm and 55% had ≤2 mm of fibular displacement. We conclude that stability may not be inferred from a lack of fibular displacement on the lateral view in this population of patients. If stability is to be determined, it must be tested irrespective of fibular displacement on the lateral radiograph.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估和比较旋后外展（SE）2 损伤与应力（+）SE4 损伤的影像学表现。
回顾性研究。
学术一级创伤中心。
本研究纳入了在单一一级创伤中心就诊的 350 例骨骼成熟患者，其表现为孤立的旋后外展（SE）旋后外展旋转模式、劳厄-汉森（Lauge-Hansen）型外侧腓骨骨骨折、OTA/AO 44-B。
我们回顾了 350 例患者（185 名男性和 165 名女性），年龄 18-95 岁（平均 45 岁），均为孤立性 SE 外侧腓骨骨折。109 例 SE4 损伤[内侧间隙（MCS）=8.3mm]。241 例踝关节受应力；164 例不稳定，77 例稳定（SE2）。SE2 组在就诊时和应力位 X 线片上的平均 MCS 分别为 3.59mm，而应力（+）SE4 组分别为 3.86mm 和 5.94mm。SE2、应力（+）SE4 和 SE4 组的腓骨位移分别为 1.5（0-4.5）、3.5（0-6.6）和 4.1（0-30.5）。SE2 组有 16 例（20%）和应力（+）SE4 组有 24 例（15%）腓骨在侧位 X 线片上无移位。同样，SE2 组有 53 例（68%）和应力（+）SE4 组有 91 例（55%）腓骨的位移小于 2mm。腓骨侧位 X 线片上的位移小于 2mm 与应力检查时踝关节稳定的敏感性为 0.69，阳性预测值仅为 0.37。
既往研究表明，对于孤立性 SE 模式腓骨骨折、MCS 正常且腓骨侧位 X 线片上的腓骨位移小于 2mm 的患者，踝关节稳定性较高，阳性预测值约为 97%。我们无法证实这一发现，因为 15%的不稳定踝关节有 0mm，55%的踝关节有≤2mm 的腓骨位移。我们得出的结论是，在这群患者中，不能从腓骨侧位 X 线片上无腓骨移位来推断稳定性。如果要确定稳定性，必须在不考虑腓骨侧位 X 线片上的位移的情况下进行测试。
诊断 III 级。有关证据水平的完整描述，请参见作者说明。
