This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Letters to the Editor: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by McConnell, T.
Right arrow Articles by Tornetta, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by McConnell, T.
Right arrow Articles by Tornetta, P., III
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery (American) 86:2171-2178 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Stress Examination of Supination External Rotation-Type Fibular Fractures

Timothy McConnell, MD1, William Creevy, MD1 and Paul Tornetta, III, MD1

1 Boston University Medical Center, 818 Harrison Avenue, Boston, MA 02118. E-mail address for P. Tornetta III: ptornetta{at}pol.net

Investigation performed at Boston University Medical Center, Boston, Massachusetts

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Aircast, Inc. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated..

Background: Deltoid incompetence in association with an isolated fibular fracture is assumed to be present if there is medial tenderness, ecchymosis, or substantial swelling. We sought to determine whether these soft-tissue indicators predict deltoid incompetence by comparing such findings with the findings on stress radiographs.

Methods: Over a thirty-two-month period, 138 patients who presented acutely with a Weber type-B supination-external rotation (SE) fibular fracture were evaluated for tenderness (in nine locations), ecchymosis, and swelling. Patients who presented with an apparently isolated fibular fracture and an intact ankle mortise (with a medial clear space of ≤4 mm and no talar subluxation) were evaluated with a stress radiograph to determine deltoid competence. Four groups of patients were identified: those who had an SE2 fracture (defined as those who had a stable ankle on the stress radiograph), those who had a stress (+) SE4 fracture (defined as those who had an unstable ankle on the stress radiograph), those who had an SE4 fracture (defined as those who presented with a wide medial clear space), and those who had a bimalleolar fracture. These four groups were compared with regard to tenderness, swelling, and ecchymosis at the time of initial presentation. Patients with SE2 injuries were allowed immediate weight-bearing.

Results: Of the ninety-seven patients who presented with an isolated fibular fracture and an intact mortise, sixty-one had a stable SE2 injury and thirty-six had an unstable stress (+) SE4 injury. All stable SE2 injuries healed with an intact mortise. Medial tenderness, ecchymosis, and swelling were not predictive of deltoid incompetence (instability).

Conclusions: Stress radiographs allow for the accurate diagnosis of deltoid incompetence in patients with Weber type-B SE fibular fractures and no other osseous injury. Soft-tissue indicators are not accurate predictors of instability. If medial tenderness, ecchymosis, and swelling are used as operative indications, in some cases surgery may be performed on stable ankles.

Level of Evidence: Diagnostic study, Level II-1 (development of diagnostic criteria on basis of consecutive patients [with universally applied reference "gold" standard]). See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 J Am Acad Orthop SurgHome page
C. Zalavras and D. Thordarson
Ankle Syndesmotic Injury
J. Am. Acad. Ortho. Surg., June 1, 2007; 15(6): 330 - 339.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
J. B. Gill, T. Risko, V. Raducan, J. S. Grimes, and R. C. Schutt Jr.
Comparison of Manual and Gravity Stress Radiographs for the Evaluation of Supination-External Rotation Fibular Fractures
J. Bone Joint Surg. Am., May 1, 2007; 89(5): 994 - 999.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
P. A. Cole and M. Bhandari
What's New in Orthopaedic Trauma
J. Bone Joint Surg. Am., December 1, 2005; 87(12): 2823 - 2838.
[Full Text] [PDF]

Letters to the Editor:

Read all Letters to the Editor

Assessment of the Deltoid Ligament Complex
James D. Michelson
JBJS Online, 16 Nov 2004 [Full text]
Radiographic Indicators of Ankle Instability
John F. Kragh, Jr., M.D., et al.
JBJS Online, 7 Dec 2004 [Full text]