Although radiographs and CT depict ossific fragments and fracture lines, cartilage abnormalities and bone contusions related to osteochondral lesion are best seen on MRI. Seventy percent of ankle fractures and 50% of ankle sprains have been shown to result in some variation of cartilage injury [57,58,61,64]. Fractures Although CT is more commonly used as the next step in fracture assessment in known fractures, MRI can be useful as a follow-up imaging modality for assessment of associated bone marrow contusions, stress injuries, or fractures [65]. MRI is especially important in fracture sites such as the talus, which are at higher risk for osteonecrosis. MRI is highly accurate for associated soft-tissue abnormalities including tendon entrapment/dislocation and for ligamentous injuries [66]. US Ankle Osteochondral lesion US is not the next step in this clinical scenario. Fractures US has been shown to be useful for identification of lateral malleolar, medial malleolar, and fifth metatarsal fractures [41] but is not considered a first-line assessment tool or next imaging study in this clinical scenario. Variant 6: Adult or child 5 years of age or older. Acute trauma to the ankle. Radiographs negative for osseous injury and physical examination or radiographs demonstrate alignment abnormality suggesting syndesmotic/ligamentous injury or dislocation. Next study. Lateral sprain is more common than medial strain, with the anterior talofibular ligament most commonly torn. High sprain and fractures are more common in high-collision sport injuries [60], with higher incidence of ankle injuries during winter months [67] and increased incidence in military recruits [68]. Inversion injuries of the ankle account for 25% of musculoskeletal system injuries and 50% of all sports-related injuries [1]. Bone Scan Ankle Bone scan is not routinely the next line of imaging in this clinical scenario. Acute Trauma to the Ankle
Acute Trauma to the Ankle. Although radiographs and CT depict ossific fragments and fracture lines, cartilage abnormalities and bone contusions related to osteochondral lesion are best seen on MRI. Seventy percent of ankle fractures and 50% of ankle sprains have been shown to result in some variation of cartilage injury [57,58,61,64]. Fractures Although CT is more commonly used as the next step in fracture assessment in known fractures, MRI can be useful as a follow-up imaging modality for assessment of associated bone marrow contusions, stress injuries, or fractures [65]. MRI is especially important in fracture sites such as the talus, which are at higher risk for osteonecrosis. MRI is highly accurate for associated soft-tissue abnormalities including tendon entrapment/dislocation and for ligamentous injuries [66]. US Ankle Osteochondral lesion US is not the next step in this clinical scenario. Fractures US has been shown to be useful for identification of lateral malleolar, medial malleolar, and fifth metatarsal fractures [41] but is not considered a first-line assessment tool or next imaging study in this clinical scenario. Variant 6: Adult or child 5 years of age or older. Acute trauma to the ankle. Radiographs negative for osseous injury and physical examination or radiographs demonstrate alignment abnormality suggesting syndesmotic/ligamentous injury or dislocation. Next study. Lateral sprain is more common than medial strain, with the anterior talofibular ligament most commonly torn. High sprain and fractures are more common in high-collision sport injuries [60], with higher incidence of ankle injuries during winter months [67] and increased incidence in military recruits [68]. Inversion injuries of the ankle account for 25% of musculoskeletal system injuries and 50% of all sports-related injuries [1]. Bone Scan Ankle Bone scan is not routinely the next line of imaging in this clinical scenario. Acute Trauma to the Ankle