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The predictive value of MRI in the syndesmotic instability of ankle fracture

Skeletal Radiology volume 47, pages 533–540 (2018)Cite this article

Abstract

Objective

Although many types of ankle fracture can be combined with syndesmosis injury, preoperative imaging studies rarely reveal instability of the syndesmosis. This study assessed the use of magnetic resonance imaging (MRI) for syndesmotic instability in patients with unstable ankle fracture.

Methods

A total of 74 patients who were treated for Lauge-Hansen supination external rotation/Weber B type fracture or pronation external rotation/Weber C type fracture and who underwent MRI for preoperative assessment were enrolled. The MRI findings of the syndesmotic ligament and the results of an intraoperative stress test were evaluated.

Results

Twenty-six patients had a positive result on the intraoperative stress test for syndesmotic instability. The MRI findings of the syndesmotic ligaments revealed that complete tear of the posterior inferior tibiofibular ligament (PITFL) was the most reliable predictor of syndesmotic instability (sensitivity, 74%; specificity, 78%; positive predictive value, 54%). Interobserver agreement for the intraoperative stress test and MRI assessment was excellent, except for the MRI findings of the interosseous ligament (62% agreement; kappa, 0.3).

Conclusions

Complete tear of the PITFL on MRI has additional diagnostic value for syndesmotic instability in ankle fracture. However, because the sensitivity might not be sufficient to justify the costs associated with MRI, cost-effectiveness should be considered.

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Author information

Affiliations

  1. Department of Orthopedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea

    Young Hwan Park, Won Seok Choi & Hak Jun Kim

  2. Department of Radiology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea

    Min A. Yoon & Suk Joo Hong

  3. Department of Orthopedic Surgery, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, South Korea

    Gi Won Choi

Authors
  1. Young Hwan Park
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  2. Min A. Yoon
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  3. Won Seok Choi
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  4. Gi Won Choi
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  5. Suk Joo Hong
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  6. Hak Jun Kim
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Contributions

Y. H. Park: Designed the study, lead investigator, and first author.

M. A. Yoon: Study implementation, data analysis and interpretation, review of the manuscript.

W. S. Choi: Study implementation, data analysis and interpretation.

G. W. Choi: Study implementation, data analysis and interpretation.

S. J. Hong: Designed the study, study implementation, data analysis and interpretation.

H. J. Kim: Designed the study, Corresponding author, Primary surgeon, approval of the final manuscript.

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the contents of this study.

Corresponding author

Correspondence to Hak Jun Kim.

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Park, Y.H., Yoon, M.A., Choi, W.S. et al. The predictive value of MRI in the syndesmotic instability of ankle fracture. Skeletal Radiol 47, 533–540 (2018). https://doi.org/10.1007/s00256-017-2821-4

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  • DOI: https://doi.org/10.1007/s00256-017-2821-4

Keywords

  • Ankle fracture
  • Intraoperative stress test
  • Magnetic resonance imaging
  • Syndesmotic instability