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Chiropractic Research Review

Radiography Inadequate for Persistent Ankle Sprain Symptoms

Ligament sprains of the ankle are one of the most common sports injuries. Persistent pain following an ankle sprain should be assessed for further injury, such as osteochondral contusion or fracture of the dome of the talus.

Interestingly, talar dome contusions or fractures occur more frequently than clinicians may think.

Berndt and Harty created the most widely accepted classification system for osteochondral talar injuries, which is based on 4-stage system. This study used the Berndt and Harty classification scheme to evaluate 146 images of patients who had undergone magnetic resonance (MR) imaging to determine the presence and location of subchondral bone contusions and fractures of the talotibial joint after ankle sprain.

The authors found that of the 146 ankles there were 42 osteochondral lesions found on MR imaging, involving 23 patients. Twenty-three lesions were reported in the dome of the talus and 19 were in the tibial plafond. Lesions present in the opposing bone of the joint (kissing lesions) were found in 16 images. Fifty percent of the talar fractures and all of the tibial fractures were not visible using conventional radiography.

Note: This excellent article, available on the Internet for free, highlights the importance of obtaining appropriate diagnostic imaging when typical symptoms of ankle sprain persist. Note that every one of the tibial fractures, and half of the talar fractures, found using MR imaging were missed using plain film radiographs alone!

Sijbrandij ES, van Gils APG, Louwerens JWK, de Lange EE. Possttraumatic subchondral bone contusions and fractures of the talotibial joint. American Journal of Roentgenology 2000; 175(6):http://www.ajronline.org/cgi/content/full/175/6/1707.

Chiropractic Research Review

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