Young Hwan Park1, Min A Yoon2, Won Seok Choi1, Gi Won Choi3, Suk Joo Hong2, Hak Jun Kim4. 1. Department of Orthopedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea. 2. Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea. 3. Department of Orthopedic Surgery, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, South Korea. 4. Department of Orthopedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea. hjunkimos@gmail.com.
Abstract
OBJECTIVE: Although many types of ankle fracture can be combined with syndesmosis injury, preoperative imaging studies rarely reveal instability of the syndesmosis. This study assessed the use of magnetic resonance imaging (MRI) for syndesmotic instability in patients with unstable ankle fracture. METHODS: A total of 74 patients who were treated for Lauge-Hansen supination external rotation/Weber B type fracture or pronation external rotation/Weber C type fracture and who underwent MRI for preoperative assessment were enrolled. The MRI findings of the syndesmotic ligament and the results of an intraoperative stress test were evaluated. RESULTS: Twenty-six patients had a positive result on the intraoperative stress test for syndesmotic instability. The MRI findings of the syndesmotic ligaments revealed that complete tear of the posterior inferior tibiofibular ligament (PITFL) was the most reliable predictor of syndesmotic instability (sensitivity, 74%; specificity, 78%; positive predictive value, 54%). Interobserver agreement for the intraoperative stress test and MRI assessment was excellent, except for the MRI findings of the interosseous ligament (62% agreement; kappa, 0.3). CONCLUSIONS: Complete tear of the PITFL on MRI has additional diagnostic value for syndesmotic instability in ankle fracture. However, because the sensitivity might not be sufficient to justify the costs associated with MRI, cost-effectiveness should be considered.
OBJECTIVE: Although many types of ankle fracture can be combined with syndesmosis injury, preoperative imaging studies rarely reveal instability of the syndesmosis. This study assessed the use of magnetic resonance imaging (MRI) for syndesmotic instability in patients with unstable ankle fracture. METHODS: A total of 74 patients who were treated for Lauge-Hansen supination external rotation/Weber B type fracture or pronation external rotation/Weber C type fracture and who underwent MRI for preoperative assessment were enrolled. The MRI findings of the syndesmotic ligament and the results of an intraoperative stress test were evaluated. RESULTS: Twenty-six patients had a positive result on the intraoperative stress test for syndesmotic instability. The MRI findings of the syndesmotic ligaments revealed that complete tear of the posterior inferior tibiofibular ligament (PITFL) was the most reliable predictor of syndesmotic instability (sensitivity, 74%; specificity, 78%; positive predictive value, 54%). Interobserver agreement for the intraoperative stress test and MRI assessment was excellent, except for the MRI findings of the interosseous ligament (62% agreement; kappa, 0.3). CONCLUSIONS: Complete tear of the PITFL on MRI has additional diagnostic value for syndesmotic instability in ankle fracture. However, because the sensitivity might not be sufficient to justify the costs associated with MRI, cost-effectiveness should be considered.
Authors: T J Vogl; K Hochmuth; T Diebold; J Lubrich; R Hofmann; U Stöckle; O Söllner; S Bisson; N Südkamp; J Maeurer; N Haas; R Felix Journal: Invest Radiol Date: 1997-07 Impact factor: 6.016
Authors: Lars Gerhard Großterlinden; Maximilian Hartel; Jin Yamamura; Bjoern Schoennagel; Nils Bürger; Mathias Krause; Alexander Spiro; Michael Hoffmann; Wolfgang Lehmann; Johannes Maria Rueger; Martin Rupprecht Journal: Knee Surg Sports Traumatol Arthrosc Date: 2015-04-21 Impact factor: 4.342
Authors: Michael J Gardner; Demetris Demetrakopoulos; Stephen M Briggs; David L Helfet; Dean G Lorich Journal: Foot Ankle Int Date: 2006-10 Impact factor: 2.827
Authors: Michael J Gardner; Adam Brodsky; Stephen M Briggs; Jason H Nielson; Dean G Lorich Journal: Clin Orthop Relat Res Date: 2006-06 Impact factor: 4.176
Authors: J J Hermans; N Wentink; A Beumer; W C J Hop; M P Heijboer; A F C M Moonen; A Z Ginai Journal: Skeletal Radiol Date: 2011-10-20 Impact factor: 2.199
Authors: Emilia Möller Rydberg; Jonas Skoglund; Hampus Brezicka; Jan Ekelund; Mikael Sundfeldt; Michael Möller; David Wennergren Journal: BMC Musculoskelet Disord Date: 2022-04-29 Impact factor: 2.562