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Foot and Ankle: H. J. Schock, M. Pinzur, L. Manion, and M. Stover The use of gravity or manual-stress radiographs in the assessment of supination-external rotation fractures of the ankle J Bone Joint Surg Br 2007; 89-B: 1055-1059 [Abstract] [Full text] [PDF]

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The use of gravity or manual-stress radiographs in the assessment of SER ankle fractures

Saeed Al-Naser   (11 October 2007)

The use of gravity or manual-stress radiographs in the assessment of SER ankle fractures 11 October 2007
Saeed Al-Naser, Senior House Officer, Trauma & Orthopaedics Morriston Hospital, Swansea, UK Send letter to journal: Re: The use of gravity or manual-stress radiographs in the assessment of SER ankle fractures alnasersaeed{at}yahoo.co.uk Saeed Al-Naser	Sir, I read with interest the article by Schock et al in the August 2007 issue. I agree with the authors that the use of manual stress can cause more pain to patients (measured objectively using VAS), which can be explained by the pressure applied either directly or indirectly to the fracture site on the lateral side. However, the conclusion made by the authors that gravity stress radiographs are more reliable than manual stress radiographs (which was the main point to be tested in this study) can not be accepted as the significance level of results comparing the medial clear space under stress (gravity or manual) was poor (p=0.63). In addition, including 29 patients in such a study with only 16 having stress positive tests is unlikely to achieve significant results although the methodology was rigorous. A power calculation prior to the study would have given the authors the number of patients needed to give reliable results that can be applied to clinical practice. This is not unachievable keeping in mind how common SER ankle injuries are. S. Al-Naser, Senior House Officer, Trauma & Orthopaedics, Morriston Hospital, Swansea, UK.