Probability of Occult Ankle Fracture Based on Radiograph-Measured Swelling

Pediatric ankle injuries are a common presentation in the emergency department (ED). A quarter of pediatric ankle fractures show no radiographic evidence of a fracture. Physicians often correlate non-weight bearing and tenderness with an occult fracture. We present this study to predict the probabil...

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Published inJournal of the American Academy of Orthopaedic Surgeons. Global research & reviews Vol. 8; no. 5
Main Authors Kerut, Christian Kenneth, Mudiganty, Srikanth, Kerut, Denise Goodfellow, Horswell, Ronald L, Williams, Reagan, Valencia, Melanie, Gonzales, Joseph
Format Journal Article
LanguageEnglish
Published United States Wolters Kluwer 01.05.2024
Subjects
Adolescent
Ankle Fractures - diagnostic imaging
Child
Child, Preschool
Edema - diagnostic imaging
Emergency Service, Hospital
Female
Fractures, Closed - diagnostic imaging
Humans
Male
Predictive Value of Tests
Probability
Radiography
Retrospective Studies
Weight-Bearing
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Summary:Pediatric ankle injuries are a common presentation in the emergency department (ED). A quarter of pediatric ankle fractures show no radiographic evidence of a fracture. Physicians often correlate non-weight bearing and tenderness with an occult fracture. We present this study to predict the probability of an occult fracture using radiographic soft-tissue swelling on initial ED radiographs. This is a retrospective study at a Level 1 pediatric trauma center from 2021 to 22. Soft-tissue swelling between the lateral malleolus and skin was measured on radiographs, and weight-bearing status was documented. Statistical analysis was conducted using Stata software. The study period involved 32 patients with an occult fracture, with 8 (25%) diagnosed with a fracture on follow-up radiographs. The probability of an occult fracture was calculated as a function of the ankle swelling in millimeters (mm) using a computer-generated predictive model. False-negative and false-positive rates were plotted as a function of the degree of ankle swelling. Magnitude of ankle soft-tissue swelling as measured on initial ED radiographs is predictive of an occult fracture. Although weight-bearing status was not a sign of occult fracture, it improves the predictive accuracy of soft-tissue swelling.
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ISSN:2474-7661
2474-7661
DOI:10.5435/JAAOSGlobal-D-23-00271