The value of radiologic diagnostics in evaluating deltoid integrity in isolated type B ankle fractures: a systematic review of the literature.

INTRODUCTION Excluding deep deltoid ligament (DDL) rupture in isolated type B ankle fractures is crucial in the decision-making process for surgical or conservative treatment. There is no consensus about the most accurate radiologic diagnostic test to determine medial injury. The aim of this study is to systematically review the literature concerning radiologic diagnostics that evaluate medial injury in adult patients with isolated type B ankle fractures. METHODS The electronic databases PubMed, Embase, Web of Science, COCHRANE Library, and Emcare were searched to identify studies published from January 1990 to December 2020 concerning sensitivity and specificity of diagnostic tests that evaluate medial injury in patients with an isolated type B ankle fracture. For inclusion, comparison to a reference test was required to provide results in terms of sensitivity, specificity, and preferably positive predictive value and negative predictive value RESULTS: This review included 8 studies. Ultrasound showed the highest sensitivity of 100% and a specificity between 90 and 100% for detecting DDL rupture. Gravity stress radiographs showed a sensitivity of 71-100% and a specificity between 88 and 92%. The mortise, external rotation stress test, and MRI had lower sensitivity and specificity values, between 65 and 88%. CONCLUSION The most accurate and available methods for diagnosing deltoid integrity seem to be the ultrasound and the GS radiograph. Further research is needed to confirm the results of this review.