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Measurement of medial clear space widening
4%
70/1775
Measurement of the tibiofibular overlap
5%
90/1775
Anterior drawer test with comparison to the contralateral ankle
2%
28/1775
External rotation stress radiograph
87%
1551/1775
Evaluation of the syndesmosis on preoperative CT scan
1%
22/1775
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The radiograph demonstrates a Weber B ankle fracture. A dynamic external rotation stress test with the ankle dorsiflexed to 90 degrees is the most accurate way to evaluate the integrity of the syndesmosis. Nielson et al evaluated 70 ankle fractures with radiographs and MRI. Neither measurements of the tibiofibular clear space nor the tibiofibular overlap correlated with syndesmotic injury on MRI. Medial clear space widening of more than 4 mm occurred with MRI evidence of disruption of the deltoid and the tibiofibular ligaments. Nielson et al used this same cohort of ankle fractures in a separate study to evaluate whether the level of the fibular fracture correlated with syndesmotic incompetence. They found no correlation. The level of fracture on the fibula cannot be used to accurately predict disruption of the syndesmosis. Ebraheim et al reviewed a series of Weber B fibula fractures with deltoid injury and syndesmotic disruption. Their findings concluded that the surgeon's dynamic assessment of syndesmotic stability was more predictive of syndesmotic stability than any imaging parameters including radiographs and CT scans.
4.1
(22)
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