The concept of ring of injuries: evaluation in ankle trauma.

Objective: Radiographs are first-line imaging in ankle trauma but lack sensitivity to detect ligamentous injuries and undisplaced fractures. Our hypothesis was that ankle injuries occur in predefined sequences along two osteoligamentous rings, so that occult injuries non-visible on initial radiograp...

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Publicado en:Skeletal Radiology Vol. 51; no. 10; pp. 2027 - 2038
Autores principales: Nicolai, Caroline, Bierry, Guillaume, Faruch-Bilfeld, Marie, Sans, Nicolas, Willaume, Thibault
Formato: Journal Article
Publicado: Springer Nature Oct2022
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Oct2022
      vid: 51
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      pub: Springer Nature
      place: New York, New York
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        158547145
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        NLM35501494
        10.1007/s00256-022-04062-0
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        atl: The concept of ring of injuries: evaluation in ankle trauma.
      aug:
        au:
          Nicolai, Caroline
          Bierry, Guillaume
          Faruch-Bilfeld, Marie
          Sans, Nicolas
          Willaume, Thibault
        affil: Department of Radiology, Strasbourg University Hospital, 1 Avenue Moliere, 67098, Strasbourg, France
      sug:
        subj:
          Fractures
          Ankle Fractures
          Ankle Injuries
          Retrospective Design
          Adult
          Ankle Joint
          Ankle
          Adult: 19-44 years
      ab: Objective: Radiographs are first-line imaging in ankle trauma but lack sensitivity to detect ligamentous injuries and undisplaced fractures. Our hypothesis was that ankle injuries occur in predefined sequences along two osteoligamentous rings, so that occult injuries non-visible on initial radiographs can be predicted. We, therefore, aimed to validate a ring model of progressive damages in the interpretation of ankle trauma radiographs.Methods: This study retrospectively enrolled 277 adult patients that presented an acute fibular fracture on ankle radiographs between May and November 2019. Four different types of fibula fracture were differentiated, each being considered to correspond to a different mechanism of injury. Patients were classified into four groups, upon the appearance of their fibular fracture. Then, injuries to the distal tibiofibular syndesmosis, medial malleolus, and deltoid ligament (medial clear space) were assessed in each patient radiographs. Traumatic injuries were independently evaluated by a resident and an experienced MSK radiologist. For each patient, observed features were compared to those predicted by the ring concept. Inter- and intraobserver agreements were calculated.Results: Injuries were observed according to the predictable sequence in 266 of the 277 patients (96%). In the 11 remaining patients, discordances were presumably due to undisplaced injuries to the syndesmosis or deltoid ligament. Agreements were considered very good for each evaluated item.Conclusion: The Lauge-Hansen ring concept was found to be highly accurate and reproducible for radiographic assessment of ankle injuries. Discordances to the predicted sequence might reflect occult injuries, especially of the syndesmosis or deltoid ligament.
      pubtype: Academic Journal
      doctype: Journal Article
      ougenre: Article
    language: English
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