These clinical decision rules have a high sensitivity, but a very low specificity, resulting in a large number of normal radiographs despite positive OAR findings. 1 Therefore, efforts have been made in recent years to rule-out ankle fracture by means other than radiography, most notably through the use of the OARs. While ankle injuries are a common presenting complaint in the ED, only 15% of undifferentiated patients presenting with ankle injury can be expected to have evidence of ankle fracture on plain radiographs. At follow up, orthopedics recommended that she continue use of the walking boot for 4–6 weeks. Given this diagnosis, the patient was managed with a medical walking boot, acetaminophen/codeine for pain management and outpatient orthopedic follow up in 2–3 days. These views demonstrated a non-displaced Weber B fracture of the left fibula ( Image 2). Due to the US findings suggestive of fracture, stress view radiographs of the left foot, ankle and leg were obtained with orthopedic consultation. Plain radiographs of the left ankle, foot and lower leg were then obtained, which failed to demonstrate evidence of left fibular fracture. Longitudinal views of the left distal fibula demonstrated an obvious cortical defect of the left lateral malleolus consistent with fracture ( Image 1). The remainder of the physical exam was unremarkable. Sensation was intact over the foot and ankle, and the pedal pulses were intact. Passive range of motion was limited due to pain, and the patient could not bear weight on the left foot. There was mild tenderness over the medial malleolus, and no tenderness to the base of the fifth metatarsal. There was tenderness to palpation over the distal aspect of the left lateral malleolus and the calcaneofibular and anterior talofibular ligaments. Examination of the left ankle revealed intact skin and moderate soft tissue swelling. On physical examination, she was in mild distress with stable vital signs. She reported no history of surgery or trauma to the ankle prior to the presenting injury. The patient presented approximately one hour after the injury. This report describes the value of point-of-care ultrasound (POCUS) as a supplemental imaging modality in the evaluation of ankle injuries to aid in making the diagnosis of ankle fracture.Ī 45-year-old previously healthy woman presented to the ED with a chief complaint of left ankle pain after a fall while roller skating, which resulted in an inversion injury to the left ankle. Furthermore, radiographic imaging necessitates radiation exposure and additional cost. Additionally, plain film radiography is not completely sensitive for ankle fracture, resulting in false negatives. This results in many false positives with increased radiation exposure and additional costs. The OARs are designed to decrease radiographic evaluation of ankle injuries they have a high sensitivity but very low specificity for fracture diagnosis. The current standard of care for the evaluation and diagnosis of ankle fracture, when indicated by the Ottawa Ankle Rules (OARs), is plain film radiography. 1 It is important to accurately differentiate ankle fractures and other serious injuries requiring orthopedic consultation from less serious injuries that may be managed conservatively. Ankle injuries are a common presenting complaint in the emergency department (ED), comprising approximately 5% of all ED visits.
0 Comments
Leave a Reply. |