University of Dallas Medical Department, Baylor College of Medicine, University in Houston, Houston, TX.
J Orthop Trauma. 2021 Dec 1;35(12):e475-e480. doi: 10.1097/BOT.0000000000002127.
(1) To evaluate adequacy and reproducibility of the gravity and manual stress imaging in the diagnosis of unstable ankle fractures and (2) to evaluate the diagnostic utility of lateral talar displacement ratio (LTDR) derived in relation to the talar body width on ankle stress imaging.
Retrospective cohort study.
Level 1 Trauma Center.
One hundred seventy consecutive patients who presented with supination-external rotation 2 ankle fractures (OTA/AO 44-B2.1) requiring dynamic stress testing.
Dynamic stress imaging to determine ankle stability.
Ankle instability and subsequent need for surgical fixation as determined by dynamic stress imaging.
No statistical significant difference was found between the adequacy of gravity stress radiographs and manual stress images in regards to surgical decision-making (P = 0.595). Using manual and gravity stress images, receiver operating characteristic curves were generated for medial clear space (MCS) (area under the curve = 0.793, 0.901) and LTDR (0.849, 0.850), corresponding to thresholds of 10.5% and 10.2% for manual and gravity, respectively. Seventy-three of 105 patients (69.5%) with MCS > 5 mm and 62 of 75 patients (82.7%) with LTDR > 10% were offered surgical intervention. Sixty-two of the 77 patients (80.5%) offered surgery had both MCS > 5 mm and LTDR > 10%.
This study shows that manual stress radiographs are just as effective as gravity stress radiographs in making an assessment of ankle fracture stability as there was no difference in diagnostic value between gravity and manual stress imaging in regards to surgical decision-making. Use of additional radiographic measurements such as the LTDR can provide additional information in determining stability when MCS is within a clinical gray area.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
（1）评估重力和手动压力成像在不稳定踝关节骨折诊断中的充分性和可重复性；（2）评估与距骨体宽度相关的距骨外侧位移比（LTDR）在踝关节压力成像中的诊断效用。
回顾性队列研究。
1 级创伤中心。
170 例连续患者，他们因外旋外旋 2 型踝关节骨折（OTA/AO 44-B2.1）而出现旋前，需要进行动态压力测试。
动态压力成像以确定踝关节稳定性。
动态压力成像确定的踝关节不稳定和随后需要手术固定。
在手术决策方面，重力应力射线照相和手动应力图像的充分性之间没有发现统计学上的显著差异（P = 0.595）。使用手动和重力压力图像，为内侧间隙（MCS）（曲线下面积= 0.793，0.901）和 LTDR（0.849，0.850）生成了接收器操作特性曲线，分别对应于手动和重力的阈值为 10.5%和 10.2%。73 例 MCS > 5 毫米的 105 例患者和 62 例 LTDR > 10%的 75 例患者接受了手术干预。62 例接受手术的 77 例患者中，62 例 MCS > 5 毫米和 LTDR > 10%。
这项研究表明，手动射线照相与重力射线照相一样有效，可以评估踝关节骨折的稳定性，因为在手术决策方面，重力和手动压力成像在诊断价值方面没有差异。当 MCS 处于临床灰色区域时，使用 LTDR 等额外的放射学测量可以提供稳定性的额外信息。
诊断 III 级。请参阅作者说明，以获取完整的证据水平描述。
