Abstract
BackgroundThe purpose of this study was to determine the diagnostic accuracy of ultrasonography for the diagnosis of avulsion fractures of the distal fibula for lateral ankle sprain in children and compare it to that of radiography.MethodsChildren who sustained lateral ankle sprain were prospectively surveyed. They underwent both ultrasonography and radiography at the first clinic visit to diagnose any concomitant avulsion fractures of the distal fibula. The patients underwent follow-up radiography 4 weeks later to obtain the reference standard diagnosis. The measures of diagnostic accuracy (i.e., sensitivity, specificity, positive predictive value, and negative predictive value) of the initial ultrasonography and radiography were calculated; they were then compared using the McNemar test. Totally, 52 patients (with a median age of 9 years) were analyzed.ResultsOn the reference standard (follow-up) radiographs, 32 patients (62%) were found to have avulsion fractures of the distal fibula. The sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography were 94, 85, 91, and 89% respectively; and 81, 100, 100, and 77% respectively for radiography at the first visit. There were no significant differences in sensitivity and specificity between the two diagnostic methods (P = 0.22, 0.25).ConclusionsUltrasonography has a high diagnostic accuracy, which is comparable to that of radiography, for the diagnosis of avulsion fracture of the distal fibula. Ultrasonography may be used as an option of imaging modality for lateral ankle sprain in children.
Highlights
The purpose of this study was to determine the diagnostic accuracy of ultrasonography for the diagnosis of avulsion fractures of the distal fibula for lateral ankle sprain in children and compare it to that of radiography
Avulsion fractures of the distal fibula, which is the insertion of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) [2], frequently occur concomitantly with lateral ankle sprain in children with an incidence as high as 60 to 70% [3,4,5]
On the ultrasonography and radiography at the first visit, 33 (63%) and 26 (50%) patients were diagnosed with avulsion fractures, respectively
Summary
The purpose of this study was to determine the diagnostic accuracy of ultrasonography for the diagnosis of avulsion fractures of the distal fibula for lateral ankle sprain in children and compare it to that of radiography. Avulsion fractures of the distal fibula, which is the insertion of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) [2], frequently occur concomitantly with lateral ankle sprain in children with an incidence as high as 60 to 70% [3,4,5]. Several studies have shown that a majority of children with lateral ankle sprain returned to daily activity within 1 to 3 months regardless of the presence of avulsion fracture [6]. The presence or absence of avulsion fracture is clinically important, as it can affect the prognosis and treatment of the injury
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