Improving the detection of radiographically occult ankle fractures: Positive predictive value of an ankle joint effusion

• Published in: Clinical radiology Vol. 51; no. 9; pp. 632 - 636
• Main Authors: Clark, T.W.I., Janzen, D.L., Logan, P.M., Ho, K., Connell, D.G.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01-09-1996; Elsevier
• Subjects: Adult; Aged; Ankle Injuries - diagnostic imaging; Biological and medical sciences; Exudates and Transudates - diagnostic imaging; Fractures, Bone - diagnostic imaging; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Middle Aged; Osteoarticular system. Muscles; Predictive Value of Tests; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sensitivity and Specificity; Soft Tissue Injuries - diagnostic imaging; Tomography, X-Ray Computed; Human; Edema; Radiodiagnosis; Radiologic sign; Diseases of the osteoarticular system; Lower limb; Fracture; Trauma; Ankle; Radiography; Soft tissue; Computerized axial tomography; Diagnosis
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/S0009-9260(96)80057-2

To assess the value of an ankle effusion on plain radiographs as a predictor of radiographically occult fracture after acute ankle trauma.
Consecutive patients with acute ankle trauma and radiographic evidence of an ankle joint effusion. Patients were excluded if ankle trauma was sustained more than 48 h previously or if a fracture was visible on initial photographs
All subjects (
n = 26) underwent computed tomography (CT) of the ankle in sagittal and coronal planes. Ankle effusion size was measured from initial lateral ankle radiographs.
Twelve patients (46%) had radiographically occult fractures identified with CT. Fracture sites included: posterior or lateral malleoli (
n = 4), calcaneus (
n = 1), or talus (
n = 7). Ankle effusion size was 11.2 mm in the group without fracture and 17.1 mm in the group with fracture (
P < 0.0001). The positive predictive value of an effusion 15 mm or greater was 83%.
CT detected significant soft-tissue injuries in four (15%) patients including peroneal retinaculum tear (
n = 1), anterior talofibular ligament avulsion (
n = 1), and tears of the peroneus longus (
n = 1) and tibialis posterior (
n = 1) tendons.
The presence of a large ankle effusion of radiographs after acute ankle trauma suggests an underlying fracture. An ankle effusion of ≥15 mm is a reasonable threshold to prompt additional imaging. Computed tomography provides good visualization of subtle bone injuries and may detect clinically imported soft-tissue injuries.