Investigations
1st investigations to order
plain x-ray
Test
In accordance with Ottawa ankle rules, ankle x-rays should be ordered if there is posterior lateral or medial bony tenderness within 6 cm of the distal aspect of the fibula or tibia or an inability to weight-bear four steps at the scene or in the accident and emergency department.[26][27] A mortise view (15° internal rotation of the ankle) and a lateral x-ray should be obtained.[7][19][28]
Result
fracture
Investigations to consider
plain x-ray 'stress view' or a standing anteroposterior x-ray
Test
Test may be ordered if there is a suspicion of medial deltoid ligament damage (and no medial malleolar fracture identified on plain x-ray) to assess for lateral talar shift.[37]
Result
talar shift and concomitant damage to the deltoid ligament in isolated lateral malleolar fractures
CT
Test
Scan of the distal tibia and hindfoot may be ordered if comminution or significant articular involvement, for preoperative planning, to assess the impaction and to delineate all fracture components. CT imaging may be especially useful in defining fracture comminution, size, and configuration where fracture of the posterior malleolus is known or suspected.[7][33][34]
Result
comminuted fractures when clarification required
MRI
Test
The American College of Radiology recommends that MRI of the ankle may be appropriate for some patients with acute trauma.[36] However, although MRI examination may be helpful in determining articular damage and ligamentous injury, it is rarely used in practice for diagnosis or management of an acute injury.[30]
Result
ligament or tendon damage may be demonstrated
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