CT Ankle The imaging pathway is dependent on the severity of the trauma in patients within this particular clinical scenario. In the high-energy trauma patient or polytrauma patient, fractures and dislocations may be more difficult to identify clinically in the neurologically impaired or neuropathy patient. Occasionally, multidetector CT can be useful as first-line imaging study, particularly for complex injuries such as posterior malleolar fracture and posterior pilon variant fractures, which fall outside the typical classification systems. In a study of 270 patients by Switaj et al [41], the frequency of posterior malleolus fractures and posterior pilon variants was 50% and 20%, respectively; both were found more commonly in older females and diabetic patients. Recent studies of use and implementation of low-dose weight-bearing cone beam CT, particularly in the pediatric population, may be a viable alternative to standard CT studies [42]. MRI Ankle MRI is not routinely used as the first imaging study for the evaluation of acute trauma to the ankle in the setting of peripheral neuropathy or neurological disorder or other exclusionary criteria. Radiography Ankle In patients with diabetic neuropathy, neurologic compromise of the lower leg, or other exclusionary criteria in which application of the OAR is not possible and fracture is suspected, ankle radiographs are considered the initial imaging study. These patients may have no pain or point tenderness and may walk without discomfort despite fracture because of poor pain proprioception [25]. If there is high suspicion for foreign body, radiographs may also be useful for identification if the foreign body is radiopaque in nature. Radiography Ankle Stress Views Ankle stress views are not the first imaging study for the evaluation of acute trauma to the ankle in the setting of peripheral neuropathy or other exclusionary criteria.
Acute Trauma to the Ankle. CT Ankle The imaging pathway is dependent on the severity of the trauma in patients within this particular clinical scenario. In the high-energy trauma patient or polytrauma patient, fractures and dislocations may be more difficult to identify clinically in the neurologically impaired or neuropathy patient. Occasionally, multidetector CT can be useful as first-line imaging study, particularly for complex injuries such as posterior malleolar fracture and posterior pilon variant fractures, which fall outside the typical classification systems. In a study of 270 patients by Switaj et al [41], the frequency of posterior malleolus fractures and posterior pilon variants was 50% and 20%, respectively; both were found more commonly in older females and diabetic patients. Recent studies of use and implementation of low-dose weight-bearing cone beam CT, particularly in the pediatric population, may be a viable alternative to standard CT studies [42]. MRI Ankle MRI is not routinely used as the first imaging study for the evaluation of acute trauma to the ankle in the setting of peripheral neuropathy or neurological disorder or other exclusionary criteria. Radiography Ankle In patients with diabetic neuropathy, neurologic compromise of the lower leg, or other exclusionary criteria in which application of the OAR is not possible and fracture is suspected, ankle radiographs are considered the initial imaging study. These patients may have no pain or point tenderness and may walk without discomfort despite fracture because of poor pain proprioception [25]. If there is high suspicion for foreign body, radiographs may also be useful for identification if the foreign body is radiopaque in nature. Radiography Ankle Stress Views Ankle stress views are not the first imaging study for the evaluation of acute trauma to the ankle in the setting of peripheral neuropathy or other exclusionary criteria.