Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle.

Full article available online at ORTHOSuperSite.com. Search: 20110826-11 The medial deltoid ligament is the primary stabilizing structure in the ankle joint following lateral malleolar fracture. However, medial deltoid ligament ruptures are diffi cult to diagnose using current imaging modalities. We hypothesized that ultrasonography can be used to accurately allow early clinical assessment of ankle fracture stability, thereby negating the need to perform plain fi lm stress views of the acutely injured ankle. This prospective study included 12 patients (age range, 18-72) with supination external rotation fractures requiring operative fi xation. Following induction of anesthesia, ultrasonography examination was performed, followed by an arthrogram under fl uoroscopic screening. Radiographs, ultrasonography, and arthrographic fi ndings were compared. There was 100% correlation between ultrasonography and arthrogram fi ndings. Ultrasonography accurately diagnosed medial deltoid rupture with a sensitivity of 100% and specifi city of 100%. Plain fi lm radiographs of the ankle had a sensitivity of 57.1% and a specifi city of 60%. The difference between these was signifi cant ( 2 .0091). This study demonstrates diagnostic ultrasonography to be an accurate diagnostic modality in assessing medial deltoid ligament integrity in patients with supination external rotation fractures. It offers the same sensitivity and specifi city as arthrography without the need for additional invasive procedures. Its relative ease of use and lack of ionizing radiation make it a potentially useful tool, particularly in a busy trauma service. Drs Henari, Banks, Radiovanovic, Queally, and Morris are from the Department of Trauma and Orthopedics, Adelaide and Meath Hospital, Dublin, Ireland. Drs Henari, Banks, Radiovanovic, Queally, and Morris have no relevant fi nancial relationships to disclose. Correspondence should be addressed to: Shwan F. Henari, MCh, MRCSI, Midland Regional Hospital at Tullamore, Trauma and Orthopedic Surgery, Arden Rd, Tullamore, County Offaly, Ireland (shwanhenari@hotmail.com). doi: 10.3928/01477447-20110826-11 Ultrasonography as a Diagnostic Tool in Assessing Deltoid Ligament Injury in Supination External Rotation Fractures of the Ankle SHWAN HENARI, MB, BCH, BAO, MCH, IMRCS; LOUISA N. BANKS, MBCHB, MRCS, FRCS(TRO INGRID RADIOVANOVIC, MB, BCH, BAO, MRCS; JOSEPH QUEALLY, MB, BCH, BAO, MRCS; SEAMUS MORRIS, MB, BCH, BAO, MMEDSCI, MCH, AFRCSI, FRCS(TR&ORTH) e639 Figure: Ultrasonogram showing a disrupted deltoid ligament with the probe in the coronal plane. The white arrow indicates the medial malleolus, the blue arrow indicates the talus, and the red arrows indicate the disrupted deltoid ligament (A). Radiograph showing the same injury (B).