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Ankle torque-related fractures and its echo-fast diagnosis protocol

  • Joan Ferràs-TarragóEmail author
  • Juan Manuel Antequera-Cano
  • Juan Català-de-las-Marinas
  • Pablo Jordà-Gómez
  • Jose Enrique Aroca-Navarro
Original Article

Abstract

Ankle torque is the most frequent injury mechanism encountered in traumatology. It usually develops as an ankle sprain, and often produces an ankle fracture. Signs and symptoms are very unspecific on the differential diagnosis, and conventional radiographs must be obtained to confirm it. This study compares ultrasound and standard X-ray images values found in ankle sprain-related fracture diagnoses. A 3-month prospective study was carried out on 52 patients with ankle torque. First, an ultrasound diagnosis was made by the first researcher at their arrival to the emergency department, usually consisting of a longitudinal section of the fibula, tibia, and V metatarsal. Then, a blinded independent investigator carried out the usual diagnosis protocol using traditional radiographs. When the required number was obtained, a third independent investigator evaluated the results. A Chi-squared test was used to contrast the outcomes between sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) comparing a non-inferiority hypothesis of our protocol against standard X-ray images screening. Echography showed to be at least as good as standard radiographs on the screening of ankle torque-related fractures (p = 0.02). In our series of patients, nearly 8% of fractures are misdiagnosed with plain radiographies, which concurs with the lower limit found in the bibliography. All the false negatives on radiographs were true positives in the first ultrasound assessment. The average time for the ultrasound protocol was 42 s. An ultrasound is at least as effective as conventional X-ray images when used in diagnosing ankle sprain-related fractures, regardless of age or sex and could in fact be better. The use of echography could reduce the number of radiographies performed when diagnosing these kinds of fractures, thereby reducing the amount of radiation exposure and expediting the diagnostic process as well as the “in situ diagnosis”.

Level of clinical evidence 2 [prospective cohort (N > 30 patients) study].

Keywords

Ankle fracture Ankle sprain Fibula fracture 

Notes

Acknowledgements

We would like to thank all the members of the second investigator group (Copete I, López JC, Aguilar J, Cuñat B, Correa N, Alguacil J, Vila P, Hortelano S, Part J, Gómez J, Ferrando A and Pastor E) and Victoria Fornés Ferrer for the assessment with statistics.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123–40.CrossRefGoogle Scholar
  2. 2.
    Arimoto Howard KDF. Classification of ankle fractures: an algorithm. 1980.Google Scholar
  3. 3.
    Holmes JR, Acker WB 2nd, Murphy JM, McKinney A, Kadakia AR, Irwin TA. A novel algorithm for isolated weber B ankle fractures: a retrospective review of 51 nonsurgically treated patients. J Am AcadOrthop Surg. 2016;24(9):645–52.CrossRefGoogle Scholar
  4. 4.
    Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP, et al. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med. 2009;16(4):277–87.CrossRefGoogle Scholar
  5. 5.
    Brandser EA, Berbaum KS, Dorfman DD, Braksiek RJ, El-Khoury GY, Saltzman CL, et al. Contribution of individual projections alone and in combination for radiographic detection of ankle fractures. AJR Am J Roentgenol. 2000;174(6):1691–7.CrossRefGoogle Scholar
  6. 6.
    Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992;21(4):384–90.CrossRefGoogle Scholar
  7. 7.
    Wang x, Chang S, Yu G, Rao Z. Clinical value of the Ottawa ankle rules for diagnosis of fractures in acute ankle injuries. PLoS One. 2013;8(4):e63228.CrossRefGoogle Scholar
  8. 8.
    Heyworth J. Ottawa ankle rules for the injured ankle. Br J Sports Med. 2003;37(3):194.CrossRefGoogle Scholar
  9. 9.
    Brand DA, Frazier WH, Kohlhepp WC, Shea KM, Hoefer AM, Ecker MD, et al. A protocol for selecting patients with injured extremities who need X-rays. N Engl J Med. 1982;306(6):333–9.CrossRefGoogle Scholar
  10. 10.
    Hadfield JMSP. Sprain or fracture? An analysis of 2000 ankle injuries. Arch Emerg Med. 1986;3:101–6.CrossRefGoogle Scholar
  11. 11.
    Okanobo H, Khurana B, Sheehan S, Duran-Mendicuti A, Arianjam A, Ledbetter S. Simplified diagnostic algorithm for Lauge-Hansen classification of ankle injuries, vol 32. United States; 2012.Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Orthopedic Surgery and Traumatology DepartmentLa Fe HospitalValenciaSpain

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