TY  - JOUR
T1  - Comparison of Manual and Gravity Stress Radiographs for the Evaluation of Supination-External Rotation Fibular Fractures
AU  - Carney, Joseph R.
AU  - Kuhn, Kevin
Y1  - 2008/02/01
N1  - 
JO  - The Journal of Bone & Joint Surgery
SP  - 443
EP  - 443
VL  - 90
IS  - 2
N2  - 
We would like to applaud Gill et al. for their attempt to better clarify how to determine ankle stability in the presence of an isolated lateral malleolar fracture with the use of gravity stress radiographs. In their article, "Comparison of Manual and Gravity Stress Radiographs for the Evaluation of Supination-External Rotation Fibular Fractures" (2007;89:994-9), they conclude that the gravity stress radiograph is equivalent to the manual stress radiograph for determining deltoid ligament injury in association with an isolated fibular fracture. However, after closer examination of their statistical results, we believe this conclusion to be uncertain. Using gravity stress radiographs, the authors were able to find only a 0.74-mm average increase in medial clear space (from 4.26 mm to 5.00 mm) when comparing patients who had a supination-external rotation (SER) type-II fracture with patients who had a SER type-IV fracture. It is stated in the article that the p value for this difference is <0.05. This is a small increase in medial clear space, and while the stated p value implies significance we would submit that a 0.74-mm average increase in the medial clear space is not clinically relevant. One would expect a larger increase in medial clear space between an SER type-II injury and an SER type-IV injury if the incompetent deltoid ligament is being adequately evaluated.

SN  - 0021-9355
M3  - doi: 
UR  - http://dx.doi.org/
ER  -