SEARCH WITHIN CONTENT
Citation Information : Journal of Ultrasonography. Volume 15, Issue 62, Pages 259-266, DOI: https://doi.org/10.15557/JoU.2015.0022
License : (CC BY-NC-ND 3.0)
Received Date : 20-March-2015 / Accepted: 23-August-2015 / Published Online: 13-September-2016
Introduction: Sprained ankle is a very common injury in children. Proper treatment of ligament injuries enables full recovery. X-ray and US examinations are commonly available diagnostic methods. Material and methods: Two hundred and six children (113 girls and 93 boys, mean age 10.6) with recent ankle joint sprain (up to 7 days of injury) were subject to a retrospective analysis. All patients underwent an X-ray and US examination of the ankle joint within 7 days of injury. In 19 patients, anterior talofi bular ligament reconstruction was conducted. Results: X-ray failed to visualize a pathology in 129 children (63%); in 24 patients (12%), avulsion fracture of the lateral malleolus was found, and in 36 cases (17%), effusion in the talocrural joint was detected. Ultrasonography failed to visualize a pathology in 19 children (9%); in 60 patients (29%), it showed avulsion fracture of the lateral malleolus involving the attachment of the anterior talofi bular ligament (ATFL); in 34 cases (17%), complete ATFL tear was detected, and in 51 patients (25%), partial ATFL injury was found. Other injuries constituted 19%. The surgeries conducted to repair the anterior talofi bular ligament (19) confi rmed the US/X-ray diagnoses in 100% of cases. Avulsion ATFL injury, i.e. the one that involves the ligament attachment site, is usually found in younger children (median: 8 years of age). Complete ATFL tears (not involving the attachment site) concern older children (median: 14 years of age). Conclusions: Since X-ray is of limited value in diagnosing ankle joint pathologies in recent sprain injuries in children, soft tissue imaging, i.e. ultrasonography, is the basic examination to assess the ligament complex. Avulsion fractures, which involve the ATFL attachment site and are usually found in younger children, are a consequence of the incomplete ossifi cation and require urgent diagnosis and orthopedic consultation.
1. Rodineau J, Foltz V, Dupond P: [Sprained ankle in children]. Ann Readapt Med Phys 2004, 47: 317–323.
2. Garrick JG, Requa RK: The epidemiology of foot and ankle injuries in sports. Clin Sports Med 1988; 7: 29–36.
3. Renström A, Konradsen L: Ankle ligaments injuries. Br J Sports Med 1997; 31: 11–20.
4. Fong DT, Hong Y, Chan LK, Yung PS, Chan KM: A systematic review on ankle injury and ankle sprain in sports. Sports Med 2007; 37: 73–94.
5. Lynch SA, Renström A: Treatment of acute lateral ankle ligament rupture in the athlete. Sports Med 1999; 27: 61–71.
6. Dias LS: The lateral ankle sprain: an experimental study. J Trauma 1979; 19: 266–269.
7. Kumai T, Takakura Y, Rufai A, Milz S, Benjamin M: The functional anatomy of the human anterior talofi bular ligament in relation to ankle sprains. J Anat 2002; 200: 457–465.
8. Golano P, Vega J, de Leeuw PA, Malagelada F, Manzanares MC, Götzens V, Van Dijk CN: Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 2010; 18: 557–569.
9. Hsu CC, Tsai WC, Chen CP, Chen MJ, Tang SF, Shih L: Ultrasonographic examination for inversion ankle sprains associated with osseous injuries. Am J Phys Med Rehabil 2006; 85: 785–792.
10. Wang CL, Shieh JY, Wang TG, Hsieh FJ: Sonographic detection of occult fractures in the foot and ankle. J Clin Ultrasound 1999; 27: 421–425.
11. Margetić P, Pavić R: Comparative assessment of the acute ankle injury by ultrasound and magnetic resonance. Coll Antropol 2012; 36: 605–610.