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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 2/2009

Open Access 01-02-2009 | Trauma Surgery

Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature

Authors: Michel P. J. van den Bekerom, Eduard L. A. R. Mutsaerts, C. Niek van Dijk

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2009

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Abstract

Background and purpose

Review the literature concerning modalities to evaluate the integrity of the deltoid ligament in patients with supination external rotation ankle fractures.

Methods

The electronic databases Pubmed/Medline, CINAHL and Embase were searched from 1987 to November 2007 to identify all published original studies concerning diagnostic modalities to evaluate the integrity of the deltoid ligament in adult ankle fractures.

Results

This review included nine studies involving 423 ankle fractures. Three trails investigated medial tenderness; two studies, ecchymosis; two studies, swelling; one study, an injury radiograph; six studies, a type of radiographic stress view; one study, the Lauge-Hansen classification; one study, MRI; and one article studied arthroscopy in the evaluation of the deltoid ligament integrity.

Interpretation

Swelling, ecchymosis, medial tenderness, initial injury radiographs and the Lauge-Hansen classification are less adequate predictors of the integrity of the deltoid ligament. Manual or the less painful variant, the gravity external rotation stress radiographs are considered the gold standard. The amount of medial clear space widening indicative of a positive external rotation stress test has been somewhat variable in the literature but ≥5 mm is generally regarded as most reliable. Achieving adequate external rotation of the foot when obtaining stress radiographs is more important than positioning the ankle in the appropriate degree of ankle flexion. The amount of applied force necessary when performing an external rotation stress radiograph is not well defined and mainly determined by the patient’s pain level. The indication for surgery should not be based on the absolute value of one parameter but on the combination of several parameters. If nonoperative treatment is chosen despite a positive stress radiograph, close follow-up is critical because subluxation of the ankle joint is still possible. MRI could be useful in individual cases.
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Metadata
Title
Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature
Authors
Michel P. J. van den Bekerom
Eduard L. A. R. Mutsaerts
C. Niek van Dijk
Publication date
01-02-2009
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 2/2009
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-008-0768-6

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