Abstract: Background and Objectives:
Ankle sprain is one of the most common injuries in general population. Lateral ankle sprain make up a majority of these injuries and literature describes a high degree of success with quick return to function. Injury to Syndesmotic ligament occurs in 10-18 percent of all ankle sprains. Its incidence is higher in individuals participating in sports activities like football, downhill skiing and hockey. These injuries are associated with high incidence of chronic pain, significant long term complication as compared to lateral ankle sprain. Recognizing these injuries and intervening at an appropriate time is crucial to prevent long-term morbidity. The workup of these patients involve complete history, weight bearing radiographs, external rotation stress testing and in some cases MRI. In stable injuries non-operative treatment and physiotherapy may work while in unstable injuries tendon repair and other operative interventions may be required. We attempted to study the incidence of Syndesmotic injury in patients of ankle sprain by combining clinical, radiographic and ultrasound examinations. Follow up of all patients was done for 6 months to evaluate their functional outcome.
Materials and Methods: This was a prospective cohort study conducted in the orthopedics department of a tertiary care hospital situated in an urban area to find out the incidence of Syndesmotic injuries in patients with ankle sprain by combining clinical and radiological methods and to know the utility of ultrasound examination in these patients. 66 patients with history of ankle sprain were included in this study after taking into consideration inclusion and exclusion criteria. The patients were assessed on the basis of history, clinical examination, squeeze test, external rotation stress test, anterior drawer test and imaging (X-Ray and Musculoskeletal Ultrasound using high frequency probe). The incidence of Syndesmotic injuries, their mechanism, clinical and imaging evaluation and outcome was studied. The results were studied using various statistical methods. P <0.05 was taken as statistically significant. Data analysis was carried out SPSS 16.0 version software.
Results: 66 patients, 38 male and 28 female were included in the study. Most common mechanism of injury seen in this patient was found to be inversion followed by eversion type injuries which were seen in 39 (59.6%) and 22 (33.3%) patients respectively. During clinical examination Anterior drawer test, external rotation and squeeze test was positive in 15 (22.7%), 8 (12.40%) and 7 (11%) patients. Radiographically 3 patients (4.5%) were positive for disruption and on ultrasonography 8 (12.40%) patients had strain pattern and 4 (6.1%) patients had disruption. On short term follow up, patients with positive signs of Syndesmotic injury had lower functional score as compare to patients with no signs of Syndesmotic injury. However, on long term follow up, all patients had fair to good outcome. Our study shows that grade of ankle sprain does not determine long term outcome
Conclusion: In today’s world of competitive sports and vehicular accidents Syndesmotic injuries of ankle are a common occurrence. These injuries may be associated with chronic pain and instability. Ultrasound is a good diagnostic tool to evaluate and grade the Syndesmotic injury. Grade of ankle sprain have a bearing on short term morbidity but it does not seem to be affecting the long term functional outcome.