Impact of systematic ultrasonography on lateral ankle sprain management.

IF 2 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery Pub Date : 2025-09-11 DOI:10.1016/j.fas.2025.09.007

Aubin Arcade, Pierre-Henri Vermorel, Rémi Grange, Benoit Bouthin, Clément Foschia, Claire Boutet, Thomas Neri, Sylvain Grange

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引用次数: 0

Abstract

Background: Lateral ankle sprain (LAS) is the most common traumatic injury, yet its diagnosis and management remain suboptimal. This contributes to a high prevalence of residual symptoms, negatively impacting patient quality of life and increasing healthcare costs. We hypothesized that routine ultrasonography (US) following LAS could significantly modify the treatment strategy established by a specialist. Additionally, we hypothesized that US is an efficient tool for identifying osseous injuries and associated ligamentous injuries.

Methods: Fifty-one ankles with lateral instability diagnosed in the emergency department (ED) were retrospectively included. A second evaluation by an orthopedic surgeon was conducted within the first ten days to establish the "initial treatment". All patients underwent US and MRI within the first three weeks after the initial ED assessment and were reevaluated to establish the "post-US treatment". We determined concordance between initial and post-US treatment. Additionally, we assessed the diagnostic accuracy of US for identifying osseous and associated ligament injuries, including the anteroinferior talofibular ligament (AITFL), deltoid ligament, spring ligament, calcaneocuboid ligament (CCL), dorsal talonavicular ligament (DTNL), and bifurcate ligament, MRI serving as the reference standard for assessing ligamentous and osseous injuries.

Results: Treatment for LAS was modified for 16 ankles (31.3 %) following US examination (W=97, p < 0.05). US demonstrated excellent sensitivity (0.73) and specificity (0.95) for identifying osseous injuries. Additionally, US detected injuries to the AITFL in 6 ankles (11.8 %), deltoid ligament in 16 (31.3 %), spring ligament in 1 (2 %), CCL in 1 (2 %), DTNL in 1 (2 %), and bifurcate ligament in 2 (3.9 %).

Conclusion: US examination following LAS was significantly associated with treatment modifications. It also proved high accuracy for detecting osseous injuries missed by plain X-rays and diagnosing associated ligament injuries. Given these findings, it appears relevant to update the current diagnostic algorithm for LAS, including US.

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系统超声检查对踝关节外侧扭伤处理的影响。

背景：外侧踝关节扭伤（LAS）是最常见的外伤性损伤，但其诊断和治疗仍不理想。这导致残留症状非常普遍，对患者的生活质量产生负面影响，并增加医疗保健费用。我们假设在LAS之后的常规超声检查（US）可以显著改变专家制定的治疗策略。此外，我们假设US是识别骨损伤和相关韧带损伤的有效工具。方法：回顾性分析急诊诊断的51例踝关节外侧不稳患者。骨科医生在头十天内进行了第二次评估，以确定“初步治疗”。所有患者在初始ED评估后的前三周内进行了US和MRI检查，并重新评估以确定“US后治疗”。我们确定了初始治疗和us后治疗的一致性。此外，我们评估了US对骨及相关韧带损伤的诊断准确性，包括距腓骨前下韧带（AITFL）、三角韧带、弹簧韧带、跟骨立方韧带（CCL）、距舟骨背韧带（DTNL）和分叉韧带，MRI作为评估韧带和骨损伤的参考标准。结果：经US检查后，16例踝关节LAS（31.3 %）的治疗方法得到改善（W=97, p ）。结论：LAS后US检查与治疗方法改善显著相关。对于x线平片漏诊的骨性损伤和相关韧带损伤的诊断也具有较高的准确性。鉴于这些发现，似乎有必要更新现有的LAS诊断算法，包括US。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Foot and Ankle Surgery ORTHOPEDICS-

CiteScore

4.60

自引率

16.00%

发文量

202

期刊介绍： Foot and Ankle Surgery is essential reading for everyone interested in the foot and ankle and its disorders. The approach is broad and includes all aspects of the subject from basic science to clinical management. Problems of both children and adults are included, as is trauma and chronic disease. Foot and Ankle Surgery is the official journal of European Foot and Ankle Society. The aims of this journal are to promote the art and science of ankle and foot surgery, to publish peer-reviewed research articles, to provide regular reviews by acknowledged experts on common problems, and to provide a forum for discussion with letters to the Editors. Reviews of books are also published. Papers are invited for possible publication in Foot and Ankle Surgery on the understanding that the material has not been published elsewhere or accepted for publication in another journal and does not infringe prior copyright.