Clinical Utility of Point of Care Ultrasound in Severe Ankle Ligament Injuries at St. Luke’s Medical Center-QC Emergency Department

Background: The most common mechanism of ankle injury is inversion and plantar flexion, which often leads to tearing of the lateral ligaments complex. Ankle sprains are injuries commonly encountered and often under-diagnosed in the ER and little is known with regard to the best diagnostic modality for them. Numerous studies have validated the ability of ultrasound to demonstrate a wide variety of musculoskeletal disorders including acute ankle ligament injuries. It can therefore provide an efficient and inexpensive alternative to MRI for the evaluation of the acutely injured ankle. The purpose of this paper is to determine the clinical utility of point of care ultrasound in diagnosing severe ligamentous injuries (Grade II and III).

Methods: Patients 18 years old and above consulting for ankle sprain within the past 72 hours were included in the study. An independent team with an Emergency Medicine consultant conducted the initial assessment and diagnosis of the patient through physical examination. A single Emergency Medicine fellow trained in point-of-care musculoskeletal ultrasound independently conducted the ultrasound procedure. Results of the ultrasound findings were compiled and described.

Results: Seventy-nine patients were enrolled in the study. Using point-of-care ultrasound, Grade II and Grade III injuries were more prevalent on anterior talofibular ligament (ATFL) accounting for 35.4% of findings compared to calcaneofibularligament (CFL) (12.7%) and posterior talofibular ligament (PTFL) (12.7%).

Conclusion: The prevalence of severe ligamentous (Grade II and III) injuries is more prevalent on the ATFL. Ultrasound can provide a dynamic assessment of ligamentous tear and has advantages over other imaging modalities in terms of availability, comfort and safety.