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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 8, 1055-1059.
doi: 10.1302/0301-620X.89B8.19134  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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The use of gravity or manual-stress radiographs in the assessment of supination-external rotation fractures of the ankle

H. J. Schock, MD, Orthopaedic Surgeon1; M. Pinzur, MD, Orthopaedic Surgeon1; L. Manion, RN, Clinical Research Nurse1; and M. Stover, MD, Orthopaedic Surgeon1

1 Department of Orthopaedic Surgery, Loyola University Medical Centre, Maguire Build Suite 1700, 2160 S 1st Avenue, Maywood, Illinois 60153, USA.

Correspondence should be sent to Dr H. J. Schock; e-mail: hschock2{at}yahoo.com

Supination-external rotation (SER) fractures of the ankle may present with a medial ligamentous injury that is not apparent on the initial radiographs. A cadaver gravity-stress view has been described, but the manual-stress view is considered to be the examination of choice for the diagnosis of medial injuries. We prospectively compared the efficacy of these two examinations.

We undertook both examinations in 29 patients with SER fractures. Of these, 16 (55%) were stress-positive, i.e. and had widening of the medial clear space of > 4 mm with a mean medial clear space of 6.09 mm (4.4 to 8.1) on gravity-stress and 5.81 mm (4.0 to 8.2) on manual-stress examination, and 13 patients (45%) were stress-negative with a mean medial clear space of 3.91 mm (3.3 to 5.1) and 3.61 mm (2.6 to 4.5) on examination of gravity- and manual-stress respectively. The mean absolute visual analgoue scale score for discomfort in the examination of gravity stress was 3.45 (1 to 6) and in the manual-stress procedure 6.14 (3 to 10).

We have shown that examination of gravity-stress is as reliable and perceived as more comfortable than that of manual stress. We recommend using it as the initial diagnostic screening examination for the detection of occult medial ligamentous injuries in SER fractures of the ankle.




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The use of gravity or manual-stress radiographs in the assessment of SER ankle fractures
Saeed Al-Naser
J Bone Joint Surg Br Online, 11 Oct 2007 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General