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Revista Portuguesa de Ortopedia e Traumatologia

Print version ISSN 1646-2122On-line version ISSN 1646-2939


ROSA, Isabel et al. Validade e Fiabilidade do Teste Stress Manual e Gravitacional nas Fraturas Maleolares Equivalentes. Rev. Port. Ortop. Traum. [online]. 2019, vol.27, n.2, pp.79-90. ISSN 1646-2122.

Background: Can the manual and gravity stress test quality to separate populations with a malleolar fracture with or without a deltoid ligament injury? The author intends to assess validity and accuracy of the manual external rotation stress test comparing it with gravity stress radiography. Secondarily evaluate whether the medial clear space ≥4 or ≥5 mm has different predictive value for lesion of the deltoid ligament. Methods: A consecutive series of patients with isolated lateral malleolar fractures were prospectively enrolled. The sample was divided into group I (manual stress) and group II (gravity stress) with malleolar fracture with or without deltoid ligament injury. The medial clear space on the ankle’s mortise radiography was measured by blinded observers. Inter and intraobserver reliability was assessed. Results: In the sample of 65 patients, we obtained in group I a sensitivity of 97%, specificity and positive predictive value of 100%. While in the group II the sensitivity was 100%, the positive predictive value 97% and negative 100%. We found that the medial clear space ≥ 5 vs ≥ 4 mm had a sensitivity of 100% vs 91%, specificity 100% vs 100%, positive predictive value 100% vs 100% and negative 100% vs 60%. In both tests an excellent intraobserver and interobserver reliability was observed. Conclusion: A medial clear space ≥5 mm has a higher predictive value in assessing the integrity of the deltoid ligament. The manual and the gravity stress test are an effective tool in assessing the deltoid competence in isolated lateral malleolus fractures.

Keywords : Ankle fracture; deltoid ligament injury; gravity stress radiography; manual stress radiography; medial clear space.

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