Portal de Periódicos da CAPES

Roentgen Study of the Ankle in Severe Sprains and Dislocations

1945; Radiological Society of North America; Volume: 45; Issue: 1 Linguagem: Inglês

10.1148/45.1.40

1527-1315

Eugene P. Pendergrass, John O. Lafferty,

Sports injuries and prevention

There has more recently been an increasing tendency toward the use of the x-rays in clinical medicine to demonstrate not only the anatomical structure and pathological lesions of a part but also its physiology and any disturbances thereof. This is well illustrated in roentgen studies of the urinary and digestive tracts. The study of the skeletal system has not kept pace with that of other systems in this respect and, even today, is for the most part on a purely anatomical basis. In examination of the ankle, roentgenograms are obtained, as a rule, in the anteroposterior and lateral positions. If no bony injury or abnormality is demonstrable, the report usually reads: “Nothing abnormal is seen, but this examination does not exclude injury to the soft parts.” In other words, our examination fails to record the presence of a soft-tissue injury. This was brought forcibly to our attention by the following case: Case Report R. M. U., a white male, 53 years of age, was admitted to the service of Dr. Paul C. Colonna at the Hospital of the University of Pennsylvania on Sept. 19, 1943, having been thrown from a horse the day before, at which time his right foot was forced into inversion and adduction. At the time of admission the ankle was moderately swollen and extremely tender around the external malleolus and very painful on motion. There was some ecchymosis around the lateral aspect. Anteroposterior and lateral roentgenograms showed only two small smooth fragments of bone lying in the soft tissues below the internal malleolus, which were interpreted as representing an old fracture of that part (Fig. 1). Because the symptoms were suggestive of more than the usual sprain, the surgeons in charge of the case requested anteroposterior roentgenograms with the foot held in forced inversion and then in forced eversion. The study made in forced inversion showed that the talus had tilted in the ankle mortise and this had produced an increase in the joint space between the talus and the tibia (Fig. 2, A). It was felt that this indicated excessive relaxation, stretching, or tearing of the ligaments of the ankle; a report was made of a probable excess of mobility of the talus upon the tibia, and the foot was immobilized in plaster for four weeks. At the end of that time the two small fragments at the tip of the medial malleolus were unchanged, but there was no evidence of spread of the tibio-astragalar joint space on forced inversion (Fig. 2, B). Discussion Realizing from this case how little we knew of the normal ankle when it was subjected to strain, we obtained roentgenograms of six normal ankles in inversion and eversion, and in none of these found any change in either the joint space between the talus and the tibia, or in the relationship of the tibia and fibula to each other (Fig. 3, A, B, C). The ankle is a ginglymus or hinge joint which is made up of the lower end of the tibia and the malleoli of the tibia and fibula.