Correlation Between Radiodiagnosis And MRI On The Injury Of The Distal Tibioifbular Syndesmosis Of Ankle Fractures

Objective With MRI as gold standard, to caculate the sensitivity and specificity inassessing syndesmotic injury of acuter ankle fractures with the Denis-weber andLauge-Hansen fracture classifications.And to evaluate the correlation betweenradiographic measurements and the injury of syndesmotic and deltoid ligament on MRIof acute ankle fractures to provide suggestions and methods for clinical diagnosis andtreatment.Method56consecutive ankle fractures were studied by the method of date matchingdesign. Prospectively the radiographs of all fractures were classified according toDenis-weber and Lauge-Hansen fracture classifications. And the additionalmeasurements of tibiofibular clear space (TFCS), tibiofibular overlap (TFO), medialclear space (MCS) and superior clear space (SCS) were recorded according to theradiographs. Both the fracture type and additional measurements were used to assesssyndesmotic injury. MRI, as standard of reference, was performed to evaluate theintegrity of the tibiofibular syndesmosis. Then the sensitivity and specificity fordetection of syndesmotic injury with radiography were compared to MRI. FinallySpearman rank correlation analysis between radiographic measurements of bothtibiofibular clear space (TFCS) and tibiofibular overlap (TFO) and the extent of thesyndesmotic injury was performed. Additionally, Spearman rank correlation analysisbetween radiographic measurements of both medial clear space (MCS) and superiorclear space (SCS) and the extent of the deltoid ligament injury was also performed. Result On MRI the distal tibiofibular syndesmosis ligament was ruptured in41patients and intact in15patients of all56ankle fractures. The Denis-weber fractureclassification system,in combination with additional measurements, detectedsyndesmotic injury with20true-positive,21false-negative,a sensitivity of49%and aspecificity of100%.And the Lauge-Hansen with38true-positive,3false-negative,1false-positive,a sensitivity of93%and a specificity of94%. TFCS and IOL injuryshows a weak positive correlation(γs＝0.302,P＝0.031), TFCS and TRL injury shows amoderate positive correlation(γs＝0.525,P＝0.000), TF0and PITFL injury shows aweak negative correlation(γs＝-0.289,P＝0.040), TF0and IOL injury also shows aweak negative correlation(γs＝-0.310,P＝0.027),The rest of all have no significantcorrelation.Conclusion Syndesmotic injury as predicted by the Lauge-Hansen fractureclassification correlated well with MRI findings. TFCS and TFO did not absolutelycorrelate with syndesmotic injury, and a widened MCS did not correlate with deltoidligament injury.With MRI the extent of syndesmotic injury can be assessed moreaccurately compared to radiographs.