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Ankle External Rotation Test

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1. Dynamic Stress Testing Is Unnecessary for Unimalleolar Supination-External Rotation Ankle Fractures with Minimal Fracture Displacement on Lateral Radiographs. (PubMed)

Dynamic Stress Testing Is Unnecessary for Unimalleolar Supination-External Rotation Ankle Fractures with Minimal Fracture Displacement on Lateral Radiographs. This study aimed to identify factors from standard radiographs that contributed to the stability of the ankle mortise in patients with isolated supination-external rotation fractures of the lateral malleolus (OTA/AO 44-B).Non-stress radiographs of the mortise and lateral views, without medial clear space widening or incongruity, were (...) associated with ankle mortise stability were tested in multiple logistic regression. Receiver operating characteristic analyses were performed for continuous variables to determine optimal thresholds. A sensitivity of >90% was used as the criterion for an optimal threshold.According to external rotation stress radiographs, 217 patients (75.9%) had a stable injury, defined as that with a medial clear space of <5 mm. Independent factors that predicted stable ankle mortise were female sex (odds ratio

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2017 The Journal of Bone and Joint Surgery. American Volume

2. Relationship between fracture morphology of lateral malleolus and syndesmotic stability after supination-external rotation type ankle fractures. (PubMed)

Relationship between fracture morphology of lateral malleolus and syndesmotic stability after supination-external rotation type ankle fractures. Syndesmotic injury with supination-external rotation (SER)-type ankle fractures are well known for the serious damages to the osseous and soft tissue envelope. However, the Lauge-Hansen classification system does not provide sufficient information related to syndesmotic injury. In this study, we aimed to investigate factors for preoperative detection (...) of syndesmotic injury according to fracture patterns in SER III and IV ankle fractures by using radiography and computed tomography (CT).All operative SER III and IV ankle fractures treated by a single surgeon from 2009 to 2015 were enrolled in a retrospective database. Based on computed tomographic evidence and intra-operative Cotton test, stable and unstable groups of the ankle factures were divided.A total of 52 patients with SER III, 75 patients with SER IV, and 27 patients with SER IV equivalent ankle

2019 Injury

3. Ankle External Rotation Test

Ankle External Rotation Test Ankle External Rotation Test Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Ankle External Rotation Test (...) Ankle External Rotation Test Aka: Ankle External Rotation Test , Syndesmotic Stress Test II. Indications Suspected of the ankle III. Technique Patient sits on exam table with knee flexed over edge of table Examiner stabilizes leg proximal to ankle Examiner uses other hand to grasp plantar foot and dorsiflex Rotate foot externally relative to tibia IV. Interpretation Pain on external rotation suggests Images: Related links to external sites (from Bing) These images are a random sampling from a Bing

2018 FP Notebook

4. Propagation of Syndesmotic Injuries During Forced External Rotation in Flexed Cadaveric Ankles (PubMed)

will alter the propagation sequence of ankle injuries during forced external rotation of the foot.Controlled laboratory study.Matched-pair lower limbs from 9 male cadaveric specimens (mean age, 47.0 ± 11.3 years; mean height, 178.1 ± 5.9 cm; mean weight, 94.4 ± 30.9 kg) were disarticulated at the knee. Specimens were mounted in a test device with the proximal tibia fixed, the fibula unconstrained, and foot translation permitted. After adjusting the initial ankle position (neutral, n = 9; dorsiflexed, n (...) Propagation of Syndesmotic Injuries During Forced External Rotation in Flexed Cadaveric Ankles Forced external rotation of the foot is a mechanism of ankle injuries. Clinical observations include combinations of ligament and osseous injuries, with unclear links between causation and injury patterns. By observing the propagation sequence of ankle injuries during controlled experiments, insight necessary to understand risk factors and potential mitigation measures may be gained.Ankle flexion

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2018 Orthopaedic journal of sports medicine

5. Weight-Bearing Cone-Beam CT Scan Assessment of Stability of Supination External Rotation Ankle Fractures in a Cadaver Model. (PubMed)

Weight-Bearing Cone-Beam CT Scan Assessment of Stability of Supination External Rotation Ankle Fractures in a Cadaver Model. The utility of computed tomography (CT) for measuring medial clear space (MCS) for determination of the stability of supination external rotation (SER) ankle fractures and in comparison to standard radiographs is unknown. We compared MCS on gravity stress (GS) radiographs to GS and weight bearing (WB) cone-beam CT (CBCT).An AO SER 44B3.1 ankle fracture was simulated in 10 (...) human cadavers, also serving as controls. MCS was measured on GS radiographs, GS CBCT, and a simulated WB CBCT scan. Specimens were stable if MCS was <5 mm and unstable if MCS was ≥5 mm. Paired t tests were used to compare MCS from each imaging modality for controls versus SER injuries and stable versus unstable specimens.Compared with controls assessed by GS radiographs, MCS was greater for an SER injury when assessed by GS radiograph and GS CBCT scan within the stable group. Compared with controls

2018 Foot & Ankle International

6. Functional Outcome of Pronation-External Rotation-Weber C Ankle Fractures with Supracollicular Medial Malleolar Fracture Treated with or without Syndesmotic Screws: A Retrospective Comparative Cohort Study (PubMed)

Functional Outcome of Pronation-External Rotation-Weber C Ankle Fractures with Supracollicular Medial Malleolar Fracture Treated with or without Syndesmotic Screws: A Retrospective Comparative Cohort Study In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or post-bony fixation during operation is seldom be reported in previous studies (...) . The different strategies on stress test timing would exhibit opposite results within a type of pronation-external rotation (PER) fractures with supracollicular medial malleolar (SMM) fractures. This study was designed to assess the 3-year functional outcomes of the special PER fractures with or without a syndesmotic transfixation based on the results of two different intraoperative stress test strategies.This retrospective cohort study included 61 PER injury-Weber C ankle fractures combined with SMM

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2018 Chinese medical journal

7. Assessment of Ankle Mortise Instability After Isolated Supination-External Rotation Lateral Malleolar Fractures. (PubMed)

Assessment of Ankle Mortise Instability After Isolated Supination-External Rotation Lateral Malleolar Fractures. The diagnosis of clinically important instability following isolated supination-external rotation (SER) distal fibular fractures is a challenge. The purpose of this study was to investigate the accuracy of clinical findings including medial tenderness, swelling, and ecchymosis, combined with the gravity stress test and magnetic resonance imaging (MRI), in the assessment of ankle (...) mortise stability in association with isolated SER-type lateral malleolar fractures. The external rotation (ER) stress test was used as the reference with which the methods of assessment were compared.Thirty-seven patients were enrolled prospectively. Using the ER stress test as a reference, we evaluated the sensitivity, specificity, likelihood ratio (LR), and post-test probability of instability when using clinical examination, the gravity stress test, and MRI for diagnosing ankle mortise instability

2018 The Journal of Bone and Joint Surgery. American Volume

8. 3D Talar Kinematics During External Rotation Stress Testing in Hindfoot Varus and Valgus Using a Model of Syndesmotic and Deep Deltoid Instability. (PubMed)

3D Talar Kinematics During External Rotation Stress Testing in Hindfoot Varus and Valgus Using a Model of Syndesmotic and Deep Deltoid Instability. External rotation stress (ERS) identifies ankle instability after fibular reduction of rotational ankle injuries. Combined hindfoot and ankle motions and an inconsistent starting position could mask differing degrees of instability resulting from syndesmotic and/or deltoid ligament disruption. The goal of this work was to use full 3D talar (...) , tDDL+Syn during ERS-var). With ERS-val, the talar CoR moved medially (3.6-5.4 mm) and posteriorly (0.5-5.2 mm); ERS-var moved anterior/laterally or posterior/medially depending on the specific ligamentous instability. With tDDL+Syn the ankle became grossly unstable and there were no clear trends in sagittal/coronal rotation or translation.An ERS test from internal to external rotation consistently differentiates between normal, tDDL, and tDDL+Syn. Talar CoR moved outside the mortise

2019 Foot & Ankle International

9. Weightbearing vs Gravity Stress Radiographs for Stability Evaluation of Supination-External Rotation Fractures of the Ankle. (PubMed)

Weightbearing vs Gravity Stress Radiographs for Stability Evaluation of Supination-External Rotation Fractures of the Ankle. Isolated lateral malleolar fractures may result from a supination-external rotation (SER) injury of the ankle. Stable fractures maintain tibiotalar congruence due to competent medial restraints and can be treated nonoperatively with excellent functional results and long-term prognosis. Stability might be assessed with either stress radiographs or weightbearing (...) nonoperatively.Of 104 patients with isolated lateral malleolar fractures of the SER type, 14 patients were treated operatively because of clear instability (displacement) on the initial radiographs. Of the nonoperative patients, 44 patients demonstrated borderline instability on the gravity stress but stability on the weightbearing radiograph ("gravity borderline"); the remaining 46 were stable in both tests ("gravity stable"). At an average follow-up of 23 months, no significant differences were seen

2017 Foot & Ankle International

10. Weight bearing cone beam CT scan versus gravity stress radiography for analysis of supination external rotation injuries of the ankle (PubMed)

Weight bearing cone beam CT scan versus gravity stress radiography for analysis of supination external rotation injuries of the ankle For AO 44-B2 ankle fractures of uncertain stability, the current diagnostic standard is to obtain a gravity stress radiograph, but some have advocated for the use of weight-bearing radiographs. The primary aim was to compare measures of medial clear space (MCS) on weight-bearing cone beam computed tomography (CBCT) scans versus gravity stress radiographs (...) for determining the state of stability of ankle fractures classified as AO SER 44-B2 or Weber B. The secondary aim was to evaluate the details offered by CBCT scans with respect to other findings that may be relevant to patient care. Nine patients were enrolled in this cross-sectional study between April 2016 and February 2017 if they had an AO SER 44-B2 fracture of uncertain stability, had a gravity stress radiograph, and were able to undergo CT scan within seven days. The width of the MCS was measured

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2017 Quantitative imaging in medicine and surgery

11. Stability assessment of the ankle mortise in supination-external rotation-type ankle fractures: lack of additional diagnostic value of MRI. (PubMed)

with a unilateral lateral malleolar fracture resulting from an SER mechanism were enrolled. Two surgeons assessed the stability of the ankle mortise with use of an external-rotation stress test. The anterior and posterior parts of the deep deltoid ligament were investigated with 3.0-T MRI and were graded (as normal, edematous, partial tear, or complete tear) by two musculoskeletal radiologists. The medial clear space was measured and compared with the MRI findings for the deep deltoid ligament in stable (...) Stability assessment of the ankle mortise in supination-external rotation-type ankle fractures: lack of additional diagnostic value of MRI. This prospective diagnostic study assessed the utility of MRI (magnetic resonance imaging) findings for the deep aspect of the deltoid ligament in evaluating the stability of the ankle mortise in patients who have an SER (supination-external rotation)-type lateral malleolar fracture with no widening of the medial clear space.Sixty-one patients

2014 The Journal of Bone and Joint Surgery. American Volume

12. Biomechanical Comparison of Syndesmotic Repair Techniques During External Rotation Stress. (PubMed)

Biomechanical Comparison of Syndesmotic Repair Techniques During External Rotation Stress. The purpose of this study was to compare mechanical behavior of conventional syndesmosis fixation devices with new anatomic repair techniques incorporating various repair augmentations to determine which approach would return rotational ankle mechanics closer to those of an intact ankle.Ten pairs of fresh-frozen through-the-knee cadaveric lower limbs were subjected to 7.5 Nm of external rotation torque (...) specimen was tested with 2 different fixation techniques. Whole-foot rotation angles at 7.5 Nm of applied torque were measured for comparison of the different repair strategies, and reflective markers mounted on the tibia, fibula, and talus were used to track translations and rotations of the talus and the fibula relative to the tibia during testing.Syndesmotic destabilization significantly ( P < .001) increased whole-foot, talus, and fibula rotation in an axial plane and posterior fibula translation

2018 Foot & Ankle International

13. Biomechanics of external fixation of distal tibial extra-articular fractures: is spanning the ankle with a foot plate desirable? (PubMed)

Biomechanics of external fixation of distal tibial extra-articular fractures: is spanning the ankle with a foot plate desirable? To compare the mechanical stability of external fixation with and without spanning of the ankle joint with a foot plate in an in vitro model of extra-articular distal tibia fractures.A laboratory investigation was performed to evaluate the mechanical behavior of external fixation of extra-articular distal tibia fractures using a fixator with and without a foot plate (...) of spanning of the ankle with a foot plate in most cases of external fixation for unstable extra-articular and periarticular distal tibia fractures. Further studies are needed to validate these results before widespread changes in clinical treatment can be recommended.

2017 Journal of Orthopaedic Trauma

14. Supination external rotation ankle fractures: A simpler pattern with better outcomes (PubMed)

Supination external rotation ankle fractures: A simpler pattern with better outcomes Rotational injuries are the most common and usually classified as per the Lauge Hansen classification; with the most common subgroup being the supination external rotation (SER) mechanism. Isolated fractures of the distal fibula (SE2) without associated ligamentous injury are usually treated with a splint or brace and the patient may be allowed to weight bear as tolerated. This study reports the functional (...) outcomes following a stable, low energy, rotational ankle fracture supination external rotation (SER2) when compared to unstable SER4 fractures treated operatively.64 patients who were diagnosed and treated nonoperatively for a stable SER2 ankle fracture were followed prospectively. In the comparison group, 93 operatively treated fibular fractures were extracted from a prospectively collected database and evaluated comparison. Baseline characteristics obtained by trained interviewers at the time

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2015 Indian journal of orthopaedics

15. Comparison of Radiographic Stress Tests for Syndesmotic Instability of Supination External Rotation Ankle Fractures, A Cadaveric Study. (PubMed)

Comparison of Radiographic Stress Tests for Syndesmotic Instability of Supination External Rotation Ankle Fractures, A Cadaveric Study. According to the classification of Lauge-Hansen, supination-external rotation IV (OTA 44-B) injuries should not have syndesmotic instability; yet, several studies have suggested disruption is present in up to 40% of these injuries based on stress tests. In this study, we examine various stress radiographic parameters in a cadaver model of supination-external (...) by applying 100 N lateral pull at the distal fibula. True mortise radiographs were taken of intact ankles and while performing external rotation and lateral stress tests at each stage of sequentially sectioning the ankle ligaments. The deltoid ligament was sectioned first, then anterior-inferior tibiofibular ligament, posterior-inferior tibiofibular ligament, and interosseous membrane. Tibiofibular clear space and medial clear space were measured on each radiograph.External rotation stress test produced

2013 Journal of Orthopaedic Trauma

16. Preoperative Radiographic and CT Findings Predicting Syndesmotic Injuries in Supination-External Rotation-Type Ankle Fractures. (PubMed)

Preoperative Radiographic and CT Findings Predicting Syndesmotic Injuries in Supination-External Rotation-Type Ankle Fractures. The Lauge-Hansen classification system does not provide sufficient data related to syndesmotic injuries in supination-external rotation (SER)-type ankle fractures. The aim of the present study was to investigate factors helpful for the preoperative detection of syndesmotic injuries in SER-type ankle fractures using radiographs and computed tomography (CT).A cohort (...) of 191 consecutive patients (104 male and eighty-seven female patients with a mean age [and standard deviation] of 50.7 ± 16.4 years) with SER-type ankle fractures who had undergone operative treatment were included. Preoperative ankle radiographs and CT imaging scans were made for all patients, and clinical data, including age, sex, and mechanism of injury (high or low-energy trauma), were collected. Patients were divided into two groups: the stable syndesmotic group and the unstable syndesmotic

2014 The Journal of Bone and Joint Surgery. American Volume

17. Syndesmotic Fixation in Supination-External Rotation Ankle Fractures: A Prospective Randomized Study. (PubMed)

of osteoarthritis.A prospective study of 140 operatively treated patients with Lauge-Hansen SER IV (Weber B) ankle fractures was performed. After bony fixation, the 7.5-Nm standardized external rotation stress test for both ankles was performed under fluoroscopy. A positive stress examination was defined as a difference of more than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs. The patients were randomized to either syndesmotic screw fixation (13 patients (...) Syndesmotic Fixation in Supination-External Rotation Ankle Fractures: A Prospective Randomized Study. This study compared mid-term functional and radiologic results of syndesmotic transfixation with no fixation in supination external rotation (SER) ankle fractures with intraoperatively confirmed syndesmosis disruption. Our hypothesis was that early-stage good functional results would remain and unfixed syndesmosis disruption in SER IV ankle fractures would not lead to an increased incidence

2014 Foot & Ankle International

18. Ankle External Rotation Test

Ankle External Rotation Test Ankle External Rotation Test Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Ankle External Rotation Test (...) Ankle External Rotation Test Aka: Ankle External Rotation Test , Syndesmotic Stress Test II. Indications Suspected of the ankle III. Technique Patient sits on exam table with knee flexed over edge of table Examiner stabilizes leg proximal to ankle Examiner uses other hand to grasp plantar foot and dorsiflex Rotate foot externally relative to tibia IV. Interpretation Pain on external rotation suggests Images: Related links to external sites (from Bing) These images are a random sampling from a Bing

2015 FP Notebook

19. Intraoperative Assessment of the Stability of the Distal Tibiofibular Joint in Supination-External Rotation Injuries of the Ankle: Sensitivity, Specificity, and Reliability of Two Clinical Tests. (PubMed)

Intraoperative Assessment of the Stability of the Distal Tibiofibular Joint in Supination-External Rotation Injuries of the Ankle: Sensitivity, Specificity, and Reliability of Two Clinical Tests. This study was designed to assess the sensitivity, specificity, and interobserver reliability of the hook test and the stress test for the intraoperative diagnosis of instability of the distal tibiofibular joint following fixation of ankle fractures resulting from supination-external rotation forces.We (...) conducted a prospective study of 140 patients with an unstable unilateral ankle fracture resulting from a supination-external rotation mechanism (Lauge-Hansen SE). After internal fixation of the malleolar fracture, a hook test and an external rotation stress test under fluoroscopy were performed independently by the lead surgeon and assisting surgeon, followed by a standardized 7.5-Nm external rotation stress test of each ankle under fluoroscopy. A positive stress test result was defined as a side

2011 The Journal of Bone and Joint Surgery. American Volume

20. CRACKCast E058 – Ankle and Foot

the ATFL Seated with knee at 90 deg. and a neutral ankle Cup the heel with your palm while passively flexing the hip and assess for talar displacement +’ve if: “Clunk” noticed Sulcus appears antero-medially over the joint Inversion stress test Talar tilt test Assesses the ATFL and CFL Invert heel while knee is flexed at 90 degrees and ankle in neutral position +’ve if: Head of talus palpated laterally Increased laxity compared to the other side External rotation stress test Used to assess (...) the tibiofibular syndesmosis Externally rotate the foot (knee at 90, ankle neutral) +’ve with: Pain at the syndesmosis Sensation of lateral talar motion Syndesmosis stress tests: Cross-leg test Mid-calf squeeze test 3) Describe an approach to ankle x rays (including the Ottawa ankle rules) Radiology: 3 views is standard Plain radiographs miss: Subtle fractures, osteochondral lesions, stress fractures, ligament injuries Bone scan is useful for stress fractures, syndesmosis injury or osteochondral lesions CT

2017 CandiEM

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