Maastricht University Medical Centre+, Dept. of Trauma Surgery, Maastricht, The Netherlands.
Maastricht University Medical Centre+, Dept. of Trauma Surgery, Maastricht, The Netherlands.
Injury. 2022 Feb;53(2):724-731. doi: 10.1016/j.injury.2021.09.034. Epub 2021 Sep 23.
Supination-external rotation (SER) ankle fractures account for the majority of ankle fractures and can be divided into stable or unstable fractures, based on the state of the deltoid ligament. The objective of this review was to appraise the available literature concerning diagnostic tools to evaluate deltoid ligament integrity in patients with SER-type ankle fractures.
A comprehensive literature search of Pubmed and Embase was performed up to December 2020. The outcome measures were sensitivity, specificity and positive and negative predictive value of the diagnostic tools. A meta-analysis was performed to obtain an overview of sensitivity, specificity and area under the curve (AUC). The methodological quality of the articles was evaluated using Quality Assessment of Diagnostic Accuracy Studies.
A total of 12 studies investigating tools for deltoid ligament rupture in patients with SER-type ankle fractures were included. The present study found sensitivity (and specificity) ranges of 0.20-0.90 (and 0.38-0.97) for clinical features, Magnetic Resonance Imaging (MRI) 0.57-0.85 (and 0.81-1.00), ultrasonography 1.00 (and 0.89-1.00), Malleolar Medial Fleck Sign (MMFS) 0.25 (and 0.99), conventional ankle mortise radiography 0.33-0.57 (and 0.60-0.94), gravity stress radiography 0.71-1.00 (and 0.72-0.88) and manual stress ankle radiography 0.65-1.00 (and 0.00-0.77). The largest AUC was found for ultrasonography, followed by MMFS, gravity stress radiography and MRI.
Ultrasonography and gravity stress radiography seem the most accurate diagnostic tools to evaluate deltoid ligament integrity. To strengthen this conclusion, future research should use an identical reference test to ensure comparability of results. Nevertheless, present study is of high value to close the knowledge gap about which presently available diagnostic tool is to be preferred to evaluate deltoid ligament integrity in patients with SER-type ankle fractures.
旋后-外旋（SER）踝关节骨折占踝关节骨折的大多数，根据三角韧带的状态，可分为稳定型或不稳定型骨折。本综述的目的是评估评估 SER 型踝关节骨折患者三角韧带完整性的现有文献中诊断工具。
对 Pubmed 和 Embase 进行了全面的文献检索，检索时间截至 2020 年 12 月。研究结果为诊断工具的敏感性、特异性和阳性及阴性预测值。采用 meta 分析获得敏感性、特异性和曲线下面积（AUC）的概述。使用诊断准确性研究的质量评估来评估文章的方法学质量。
共纳入 12 项研究，评估了 SER 型踝关节骨折患者三角韧带断裂的工具。本研究发现，临床特征的敏感性（和特异性）范围为 0.20-0.90（和 0.38-0.97），磁共振成像（MRI）为 0.57-0.85（和 0.81-1.00），超声为 1.00（和 0.89-1.00），内踝内侧斑片征（MMFS）为 0.25（和 0.99），常规踝关节正位片为 0.33-0.57（和 0.60-0.94），重力应力位片为 0.71-1.00（和 0.72-0.88），手动应力踝关节位片为 0.65-1.00（和 0.00-0.77）。超声检查的 AUC 最大，其次是 MMFS、重力应力位片和 MRI。
超声检查和重力应力位片似乎是评估三角韧带完整性最准确的诊断工具。为了加强这一结论，未来的研究应该使用相同的参考测试，以确保结果的可比性。尽管如此，本研究对缩小目前可用的诊断工具在评估 SER 型踝关节骨折患者三角韧带完整性方面的知识差距具有很高的价值。
