HOT TOPIC: Stress Radiographs to Evaluate the Deltoid Ligament in Patients With a Distal Fibula Fracture and a Reduced Mortise on Presentation


Fractures of the distal fibula are often associated with other ankle injuries, including medial injuries to the deltoid ligament or the medial malleolus. Isolated distal fibula fractures are generally considered stable and do well with nonsurgical treatment. When the deltoid ligament is torn with a distal fibula fracture, the ankle mortise may be widened or reduced. If it is widened, the deltoid ligament injury can be deduced from the radiograph. However, some of these injuries do not demonstrate mortise widening and can result in poor ankle function and poor position of the ankle mortise if treated nonsurgically; therefore, surgical treatment is generally recommended for distal fibula fractures with associated deltoid ligament injury. This article reviews current understanding of the treatment of distal fibula fractures with questionable medial injury, and identifies the role of stress radiographs in determining indication for surgery. The associated medial injury is not "all or none" but represents a spectrum of injury, with optimal treatment based on the amount of displacement and possibly the results of alternative noninvasive testing.

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