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At least 19 recordsLinked to original sources
PubMed1991

Early local experience of ankle arthrography and its influence on management of patients with ankle injury.

Ankle arthrography was performed on 64 patients with a history of ankle injury from 21 January 1986 to 11 October 1988. There was a male predominance in the ratio of 15 to 1 and the mean age of our patients was 22 years. A total of 65 arthrograms were obtained as one patient had bilateral ankle arthrograms. Of these, 29 arthrograms were normal. A year after completing this study, we attempted to retrieve our patients' case-notes and reviewed their subsequent management. Our results showed that multiple factors influenced the further management of our patients and arthrogram did play a role in this respect.

Adolescent↗
PubMed1977

Arthrography in the diagnosis of ligament injuries and classification of ankle injuries.

Arthrography was assessed in 300 cases of ankle injury to determine its diagnostic information yield and its aid in classifying ankle injuries. No complications occurred as a result of the procedure. In 59 cases, information gained from the procedure was verified at surgery. Arthrography was considered to give valuable information in 85% of the cases of ligament ruptures.

Ankle Injuries↗
PubMed1992

Ankle injuries in athletes.

Ankle injuries are the most frequent cause of physician evaluation in a sports-oriented environment. The lateral ligaments are most commonly injured. With a detailed history, physical and radiographic examination to avoid missing underlying pathology, the primary care physician can diagnose and treat the majority of ankle injuries. Occasionally, stress radiographs, arthograms, or magnetic resonance imaging (MRI) is needed. The vast majority of ankle sprains can be treated with adhesive tape strapping or semirigid orthotics and nonsteroidal anti-inflammatory medication followed by rehabilitation. Key points of rehabilitation are control of pain and swelling acutely with nonsteroidal anti-inflammatories and RICE (rest, ice, compression, and elevation), then restoring normal range of motion, strengthening muscle groups, and retraining proprioception of the ankle joint.

Ankle↗
PubMed1979

Rationalising requests for x-ray examination of acute ankle injuries.

Radiographs of injured ankles represent about 1 in 50 of all radiological examinations. The notes and radiographs of 100 patients with ankle injuries were reviewed, and the films of a further 93 patients who had ankle fractures treated by immobilisation were also scrutinised to assess the presence of absence of soft tissue swelling over the malleoli. Any accompanying radiographs of the foot requested at the same time were also studied. In 65 of the 100 cases of ankle injury there was no soft tissue swelling, and none of the patients had a major fracture, while 92 of the 93 patients with a major fracture had soft tissue swelling at the level of the malleoli. In 32 of the 100 cases of ankle injury foot radiographs had also been requested, but only three foot injuries were found. If the simple maxim of "No swelling adjacent to a malleolus, no radiographs" were applied radiography of twisted ankles could be reduced by as much as two-thirds. Moreover, if this maxim included the rider "and no routine foot films" the total casualty radiographic work load could be reduced by 8%.

Acute Disease↗
PubMed1992

Use of radiography in acute ankle injuries: physicians' attitudes and practice.

OBJECTIVES: To examine the efficiency of the current use of radiography in patients with acute ankle injury. To study the judgements and attitudes of experienced clinicians in their use of ankle radiography and to thereby assess the potential for improved efficiency. DESIGN: Two-stage study: retrospective chart review and prospective survey. SETTING: Emergency departments of two adult teaching hospitals and one community hospital. PARTICIPANTS: The records of 1831 adults presenting with acute blunt trauma to the ankle over 5 months were examined; another 732 patients were seen by 21 full-time emergency staff physicians over a subsequent 6-month period. MEASURES AND MAIN RESULTS: Of the 1831 patients with an ankle injury in stage 1, 94.9% had had at least one radiographic series; the yield for clinically important fractures was 12.8%. In stage 2, experienced physicians predicted the probability of fracture to be 0% or 10% in 57.8% of cases. The kappa (kappa) level for interobserver agreement in 98 patients seen independently by two physicians was 0.55 (95% confidence interval [CI] 0.39 to 0.72). The area under the receiver operating characteristic curve for physicians' predicted probability was 0.88 (95% CI 0.84 to 0.92), reflecting good discrimination between fracture and nonfracture cases. Likelihood ratios for predicted probabilities ranged from 0.08 for the 0% level to 151 for the 100% level. The physicians indicated that they would feel comfortable or very comfortable in not ordering radiography in 45.9% of cases (kappa level 0.52; 95% CI 0.34 to 0.70). CONCLUSIONS: Emergency physicians order radiography for most patients with ankle injury even though they can accurately discriminate between fracture and nonfracture cases and clearly expect most of the radiographs to give normal results. These findings suggest great potential for a more efficient use of radiography in patients with ankle injury, possibly through the use of guidelines.

Adult↗
PubMed1991

Audit of ankle injuries in an accident and emergency department.

OBJECTIVE: To determine whether the treatment of ankle injuries in an accident and emergency department could be improved by an audit of existing treatment and the creation and use of a protocol. DESIGN: The study consisted of three parts: a review of the current treatment and published reports on treatment, the formation of a protocol, and a study of treatment after introducing the protocol. SETTING: Accident and emergency department of a district general hospital. PATIENTS: 550 patients attending the department with ankle injuries over four months. RESULTS: The review of treatment showed that patients with fractures were detected and treated adequately, but most had radiography. Patients with ligamentous injuries may have been undertreated. After introducing the protocol the number of patients undergoing radiography was reduced from 205 (80%) to 186 (70%) (0.0027 less than p less than 0.01). In 87% of the notes reviewed the protocol had been completed. Sixty six patients with ligamentous injuries were reviewed in the department or soft tissue clinic compared with 20 before the protocol was introduced. There was a 53% reduction in inappropriate referrals to the fracture clinic (13 before v nine after). CONCLUSIONS: Using a protocol can, at little expense, improve the treatment of ankle injuries and reduce the cost of radiology in an accident and emergency department. IMPLICATION: Treatment of other conditions may be improved by introducing a protocol.

Algorithms↗
PubMed1992

Interobserver agreement in the examination of acute ankle injury patients.

The authors' objective was to describe a method for measuring interobserver agreement and to determine the reliability of physical findings used by emergency physicians to assess ankle injury patients. A 3-month prospective survey was designed for use in the emergency departments of two university hospitals. Participants were a convenience sample of 100 adult blunt ankle injury patients. Pairs of emergency staff physicians assessed 22 standardized physical findings in each patient without knowledge of the other assessment. Agreement for each variable was measured by the kappa coefficient, the ratio of actual agreement to potential agreement beyond chance. The variables with the highest interobserver agreement and their kappa values were ability to bear weight (.83); bone tenderness at the base of the fifth metatarsal (.78), at the posterior edge of lateral malleolus (.75), and at the tip of the medial malleolus (.66); and combinations of bone tenderness (.76). Less reliable variables included soft tissue tenderness (.41) or degree of swelling (.18) of the anterior talofibular ligament, ecchymosis (.39), range of motion (.33), bone tenderness at the proximal fibula (-.01), and the anterior drawer sign (-.03). High kappa values indicate that several physical findings, including ability to bear weight and selected sites of bone tenderness, may be reliably assessed in ankle injury patients. This knowledge may give physicians more confidence in their physical examination and allow development of reliable clinical guidelines to diminish the reliance on radiography in ankle injuries.

Adult↗
PubMed1992

A study to develop clinical decision rules for the use of radiography in acute ankle injuries.

STUDY OBJECTIVE: To develop decision rules that will predict fractures in patients with ankle injuries, thereby assisting clinicians in being more selective in their use of radiography. DESIGN: Prospective survey of emergency department patients over a five-month period. SETTING: Two university hospital EDs. PARTICIPANTS: One hundred fifty-five adults in a pilot stage and 750 in the main study; all presented with acute blunt ankle injuries. INTERVENTIONS: Thirty-two standardized clinical variables were assessed and recorded on data sheets by staff emergency physicians before radiography. MEASUREMENTS: Variables were assessed for reliability by the kappa coefficient and for association with significant fracture on both ankle and foot radiographic series by univariate analysis. The data then were analyzed by logistic regression and recursive partitioning techniques to develop decision rules for predicting fractures in each radiographic series. MAIN RESULTS: All 70 significant malleolar fractures found in the 689 ankle radiographic series performed were identified among people who had pain near the malleoli and were age 55 years or more, had localized bone tenderness of the posterior edge or tip of either malleolus, or were unable to bear weight both immediately after the injury and in the ED. This rule was 100% sensitive and 40.1% specific for detecting malleolar fractures and would allow a reduction of 36.0% of ankle radiographic series ordered. Similarly, all 32 significant midfoot fractures on the 230 foot radiographic series performed were found among patients with pain in the midfoot and bone tenderness at the base of the fifth metatarsal, the cuboid, or the navicular. CONCLUSION: Highly sensitive decision rules have been developed and will now be validated; these may permit clinicians to confidently reduce the number of radiographs ordered in patients with ankle injuries.

Adult↗
PubMed1992

Controlled trial of an ankle support (Malleotrain) in acute ankle injuries.

A randomized, controlled parallel-group trial has assessed 14 days' use of a new ankle support (Malleotrain, Bauerfeind, Aldershot, UK) in 220 patients (118 Malleotrain, 102 control group) with acute ankle injuries. Self-assessed pain levels were significantly lower in the group using Malleotrain at the end of the trial (P less than 0.05), as were median times taken for reduction of symptom scores to 10% (P less than 0.05) and total analgesic consumption during the trial (P less than 0.05). Overall clinical assessment scores were significantly superior in the Malleotrain group (P less than 0.02). Of those patients who received Malleotrain, 112 of 116 patients who commented (95% of all Malleotrain-treated patients) did so positively and only one patient stopped wearing the support during the trial. Malleotrain is acceptable to patients with acute ankle injuries and its use increases the rate of alleviation of symptoms. Its use should therefore be considered in the management of all such patients.

Acute Disease↗
PubMed1991

Common ankle injuries in the athlete.

The ankle is often a neglected joint by the athlete because of an inadequate understanding of the injury. Sprains and fractures are common injuries in the athlete because of the force of impact on the ankle during activity. Appropriate management of ankle injuries promotes healing and prompt return to sports activities.

Ankle Injuries↗
PubMed1976

[Classification and diagnosis of ankle injuries].

A new method for the classification of the injuries of the ankle is recommended by the author. The main types according to his classifixation are the following: pronation-flexion, pronation-extension, supination-extension, supination-flexion and supination-extension types. His classification is compared with Lauge-Hansen's and Weber's classification. Critical analysis of these two last classifications is given. The aim of the author's classification is to render help to the doctors for their every-days' curative work. The characteristic symptoms of the pronation and supination, resp., injuries are described. Attention is drawn to "Weber's lace"--this denomination is proposed by the author, since the first description is due to Weber. On the basis of the author's examinations described in his candidate's dissertation "syndesmolysis trigonum"--pathognostic for syndesmolysis--is dealt with. The "reclined" roentgenograms are dealt with. The so-called pronation reclined roentgenogram visualize the rupture of the deltoid ligament and the syndesmolysis in the same time. The sagittal reclined roentgenogram is dealth with separately, by means of which the "table-drawer" symptom may be produced.

Ankle Injuries↗
PubMed1992

[Clinical assessment of acute ankle injuries in relation to the need of radiography].

The object of the present investigation was to attempt to assess the value of some selected individual aspect of the clinical examination of patients with acute ankle injuries with tenderness, swelling or haematoma in the neighbourhood of the lateral malleolus. An attempt was made to investigate whether it was possible to differentiate the group of patients in whom radiographic examination of the ankle was necessary and whether this could be done with sufficient certainty on the basis of the clinical parameters examined. The results are presented in the form of calculation of the diagnostic frequencies. Absence of tenderness over the posterolateral edge of the lateral malleolus was found to be the clinical finding which could be employed to exclude fracture with greatest certainty, as the true negative diagnostic frequency was found to be 97.33 (90.70-99.68). This certainty is of the same magnitude as the certainty of previously selected criteria but the examination appears to be simpler and more objective.

Acute Disease↗