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DOI:10.2214/AJR.08.1092
AJR 2009; 192:W7-W12
© American Roentgen Ray Society

Clinical Observations

MRI of Isolated Distal Fibular Fractures with Widened Medial Clear Space on Stressed Radiographs: Which Ligaments Are Interrupted?

Yvonne Cheung1, Kiley D. Perrich1, Jiang Gui2, Kenneth J. Koval3 and Douglas W. Goodwin1

1 Department of Diagnostic Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH 03756.
2 Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
3 Department of Orthopedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

OBJECTIVE. Patient management choices in ankle fractures remain controversial because of ambiguities in assessing ankle stability and lack of information on the integrity of all supporting ligaments. Our objective was to use MRI to identify the range of ankle ligament injuries associated with a problematic subset of ankle fracture: isolated fibular fractures for which widened medial clear space is absent or minimal on standard ankle radiographs but evident on stress images.

CONCLUSION. In our retrospective study of 19 patients, we have categorized ligament injury and found partial or complete tears in all cases in at least two of the four major ligament groups—usually the deltoid and syndesmosis groups. The anterior inferior tibiofibular ligament of the syndesmosis suffered complete interruption in every case. The posterior tibiotalar ligament of the deltoid group, a major contributor to stability, was generally injured but, unexpectedly, most of these tears were partial.

Keywords: ankle fracture • fibula • ligaments • MRI


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