Epidemiology of injuries due to ankle sprain diagnosed in an orthopedic emergency room.

Pedro Debieux,Nacime Salomão Barbachan Mansur,Andre Wajnsztejn

doi:10.31744/einstein_journal/2020ao4739

Abstract

ABSTRACTObjective To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray.Methods We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described.Results Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries.Conclusion There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.

Highlights

Ankle ligament injuries are among the most prevalent traumatic conditions in the emergency room.[1,2,3] Albeit widely studied, injuries are generally described jointly as lateral or medial ligament complexes and are rarely individualized
Depending on the level of energy, ankle and foot position, sprain direction, bone and soft tissue envelope quality, trauma may have different outcomes and diagnoses.[6]. When appropriately managed, most ankle sprains progress to lateral ligament injuries[7] that have good prognosis, and generally do not require many subsidiary tests, which increase costs and delay treatment of patients.[5]. Such injuries can be diagnosed through a meticulous physical examination, together with good quality radiographs of the segment studied
Clinical assessment on the fifth day after trauma showed a sensitivity of 96% and a specificity of 84%, and a positive predictive value of 95% for ligament injury in the association between pain upon palpation of the anterior talofibular ligament (ATFL), presence of hematoma and positive anterior drawer test of ankle

Summary

Introduction

Ankle ligament injuries are among the most prevalent traumatic conditions in the emergency room.[1,2,3] Albeit widely studied, injuries are generally described jointly as lateral or medial ligament complexes and are rarely individualized. Clinical assessment on the fifth day after trauma showed a sensitivity of 96% and a specificity of 84%, and a positive predictive value of 95% for ligament injury in the association between pain upon palpation of the anterior talofibular ligament (ATFL), presence of hematoma and positive anterior drawer test of ankle. These authors used ankle arthrography as a gold standard to compare findings.[8]

Methods

Results

Discussion

Conclusion