Department of Trauma Surgery, Haaglanden Medical Center, Hague, The Netherlands.
Department of Radiology, Haaglanden Medical Center, Hague, The Netherlands.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):2287-2296. doi: 10.1007/s00068-021-01757-2. Epub 2021 Jul 31.
The aim of this study is to investigate whether weight-bearing and gravity stress radiographs have additional value in predicting concomitant deep deltoid ligamentous (DDL) injury in case of isolated Weber type B fibular fractures. This may help to make the clinically relevant distinction between unstable fractures and fractures that can be treated conservatively.
In this prospective cohort study, 90 patients with an isolated type B ankle fracture, without a medial or posterior fracture, and a medial clear space (MCS) < 6 mm on the regular mortise (RM) view were included. In all patients, an additional gravity stress (GS) view and an MRI scan were performed. Furthermore, in 51 patients, an additional weight-bearing (WB) radiograph was performed. The MCS and superior clear space (SCS) measurements of these radiographs were compared with MRI findings to measure sensitivity and specificity in excluding deep deltoid ligament (DDL) rupture.
The mean MCS on the RM view was 3.32 mm (1.73-5.93) compared to 4.75 mm (2.33-10.40) on the GS view and 3.18 mm (1.93-6.9) on the WB radiograph. MRI showed a high-grade or complete deltoid ligament tear in 25 (28%) patients. Using an MCS cut-off value of ≥ SCS + 2 mm, the RM view showed 0% sensitivity and 97% specificity in diagnosing a DDL rupture. Both the GS view (with MCS ≥ SCS + 3 mm as cut-off value) and the WB radiograph (with cut-off value MCS ≥ SCS + 2 mm) showed 6% sensitivity and 100% specificity.
The gravity stress and weight-bearing radiograph can accurately exclude DDL injury. They might have extra value in addition to the conventional mortise view in assessing the stability of isolated type B ankle fractures. This helps in deciding whether patients should be selected for operative or safe conservative treatment.
本研究旨在探讨承重位和重力位 X 线片在预测孤立型 Weber B 型腓骨骨折时并发深层三角韧带（DDL）损伤方面是否具有额外价值。这有助于在不稳定骨折和可保守治疗的骨折之间做出具有临床相关性的区分。
在这项前瞻性队列研究中，纳入了 90 例孤立型 B 型踝关节骨折患者，这些患者均无内侧或后骨折，常规踝穴正位片（RM）显示内侧间隙（MCS）<6mm。所有患者均行重力位（GS）X 线片和 MRI 检查。此外，51 例患者还进行了负重位（WB）X 线片检查。比较这些 X 线片的 MCS 和上间隙（SCS）测量值与 MRI 结果，以评估其在排除深层三角韧带（DDL）断裂方面的敏感性和特异性。
RM 位的平均 MCS 为 3.32mm（1.73-5.93），GS 位为 4.75mm（2.33-10.40），WB 位为 3.18mm（1.93-6.9）。MRI 显示 25 例（28%）患者存在高级别或完全三角韧带撕裂。使用 MCS 截断值≥SCS+2mm，RM 位诊断 DDL 撕裂的敏感性为 0%，特异性为 97%。GS 位（截断值 MCS≥SCS+3mm）和 WB 位（截断值 MCS≥SCS+2mm）的敏感性均为 6%，特异性均为 100%。
重力位和负重位 X 线片可准确排除 DDL 损伤。它们在评估孤立型 B 型踝关节骨折的稳定性方面可能具有除常规踝穴位以外的额外价值。这有助于决定患者是否应选择手术或安全的保守治疗。
