Ankle Stress Test for Predicting the Need for Surgical Fixation of Isolated Fibular Fractures

Abstract

To The Editor: With great interest, we read the article “Ankle Stress Test for Predicting the Need for Surgical Fixation of Isolated Fibular Fractures” (2004;86:2393-8), by Egol et al., about the use of the ankle stress test for detecting injury of the deltoid ligament. Assessment of the integrity of the deltoid ligament is of importance when classifying an isolated fracture of the fibula. In the case of supination-eversion trauma, it means the difference between an SE-II and an SE-IV-stage injury and a recommendation for nonoperative and operative treatment, respectively.⇓ View this table: TABLE We would like to comment on the statistical analysis. Probably due to a slip of the pen, the specificity in this report is defined as the number of cases with a negative clinical sign divided by the total number of cases with a medial clear space of ≥4 mm. With correction of the medial clear space to <4 mm instead of ≥4 mm, this problem is solved. However, we cannot reproduce the sensitivity and specificity values that the authors present in Table I. According to our calculations, the sensitivity and specificity are 55% (thirty-six of sixty-six) and 83% (twenty-nine … Corresponding author: Kenneth A. Egol, MD Department of Orthopaedic Surgery The Hospital for Joint Diseases 301 East 17th Street New York, NY 10003 ljegol{at}att.net