Department of Radiology, Strasbourg University Hospital, 1 Avenue Moliere, 67098, Strasbourg, France.
Icube Laboratory, Strasbourg University, 300 bd Sébastien Brant CS 10413, 67412, Illkirch Cedex, France.
Skeletal Radiol. 2022 Oct;51(10):2027-2037. doi: 10.1007/s00256-022-04062-0. Epub 2022 May 2.
Radiographs are first-line imaging in ankle trauma but lack sensitivity to detect ligamentous injuries and undisplaced fractures. Our hypothesis was that ankle injuries occur in predefined sequences along two osteoligamentous rings, so that occult injuries non-visible on initial radiographs can be predicted. We, therefore, aimed to validate a ring model of progressive damages in the interpretation of ankle trauma radiographs.
This study retrospectively enrolled 277 adult patients that presented an acute fibular fracture on ankle radiographs between May and November 2019. Four different types of fibula fracture were differentiated, each being considered to correspond to a different mechanism of injury. Patients were classified into four groups, upon the appearance of their fibular fracture. Then, injuries to the distal tibiofibular syndesmosis, medial malleolus, and deltoid ligament (medial clear space) were assessed in each patient radiographs. Traumatic injuries were independently evaluated by a resident and an experienced MSK radiologist. For each patient, observed features were compared to those predicted by the ring concept. Inter- and intraobserver agreements were calculated.
Injuries were observed according to the predictable sequence in 266 of the 277 patients (96%). In the 11 remaining patients, discordances were presumably due to undisplaced injuries to the syndesmosis or deltoid ligament. Agreements were considered very good for each evaluated item.
The Lauge-Hansen ring concept was found to be highly accurate and reproducible for radiographic assessment of ankle injuries. Discordances to the predicted sequence might reflect occult injuries, especially of the syndesmosis or deltoid ligament.
踝关节创伤的首选影像学检查是 X 线，但 X 线对检测韧带损伤和无移位骨折的敏感性较差。我们的假设是，踝关节损伤沿着两个骨-韧带环以预定的顺序发生，因此可以预测初始 X 线片上不可见的隐匿性损伤。因此，我们旨在验证一种踝关节 X 线片解读中渐进性损伤的环形模型。
本研究回顾性纳入了 2019 年 5 月至 11 月期间在踝关节 X 线片上出现急性腓骨骨折的 277 例成年患者。将腓骨骨折分为 4 种不同类型，每种类型均被认为对应于不同的损伤机制。根据腓骨骨折的表现，将患者分为 4 组。然后，在每位患者的 X 线片上评估下胫腓联合、内踝和距腓前韧带（内侧间隙）的损伤。由一名住院医生和一名经验丰富的 MSK 放射科医生独立评估创伤性损伤。对于每位患者，观察到的特征与环形概念预测的特征进行比较。计算了观察者间和观察者内的一致性。
277 例患者中的 266 例（96%）按照可预测的顺序出现损伤。在其余 11 例患者中，不一致可能是由于下胫腓联合或距腓前韧带的隐匿性损伤所致。对于每项评估项目，一致性均被认为非常好。
Lauge-Hansen 环形概念对于踝关节损伤的 X 线评估具有高度准确性和可重复性。与预测序列的不一致可能反映了隐匿性损伤，尤其是下胫腓联合或距腓前韧带的损伤。
