Ultrasonography for the diagnosis of deltoid injury in supination external rotation ankle fractures — A scoping review

• Published in: Foot (Edinburgh, Scotland) Vol. 51; p. 101897
• Main Authors: Black, Jonathon Douglas James, Dhillon, Govind, Tadros, Baha John, Malik-Tabassum, Khalid, Southgate, Crispin, Dhinsa, Baljinder
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01-05-2022
• Subjects: Ankle fractures; Deltoid ligament; Medial malleolus fracture; Supination external rotation; Tibiotalar ligament; Ultrasound; SER; QUADRAS-2; WB; GS; PRISMA-DTA; ER; Tibiotalar ligament; ROM; AOFAS; Medial malleolus fracture; Ankle fractures; Deltoid ligament; MCS; Supination external rotation; Ultrasound
• ISSN: 0958-2592; 1532-2963
• DOI: 10.1016/j.foot.2021.101897

•Scoping review of current available research using ultrasound to determine deltoid ligament integrity.•Ultrasound has good sensitivity and specificity for complete deltoid rupture and compares favorably to open exploration.•There are only a small number of studies investigating ultrasound to determine deltoid ligament integrity and they all have inherent limitations.•A study design that would minimise risk of bias in future research is recommended.
Lauge-Hansen supination external rotation (SER)-type ankle fractures are very common and account for up to 75% of all ankle fractures. Assessing deltoid integrity is key for surgical decision making. Ultrasound has been used recently to assess the integrity of the deltoid ligament and differentiate between SER II and SER IV fractures. The aim of this article is to review the literature for studies assessing the diagnostic accuracy of ultrasound in this group of patients.
After registering the protocol with PROSPERO, Embase, Ovid MEDLINE, Web of Science Core Collection, and Google Scholar were systematically searched. Studies that satisfied the following inclusion criteria were assessed: (1) Adult patients (>16 years), (2) Acute SER-type ankle fractures assessed within 2 weeks of the injury, (3) Diagnostic accuracy studies. Risk of bias assessment was conducted and a narrative synthesis of the results presented.
A total of five studies satisfied our inclusion criteria and were included for review. These had a total of 175 patients studied. All studies showed a sensitivity of 100% and specificity of 90–100% for detecting a complete tear of the deltoid. All papers had a significant risk of bias inherent to the design. Only patients undergoing surgery were exposed to the gold standard of operative intervention.
Ultrasound scan has shown excellent diagnostic accuracy for detecting complete deltoid ruptures in SER ankle fractures. These results however should be interpreted with caution. Perhaps a different approach is needed to assess the efficacy of ultrasound scans in patient with SER type fractures.