Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm
Hans Polzer,Karl-Georg Kanz,Wolf Christian Prall,Florian Haasters,Ben Ockert,Wolf Mutschler,S. Grote +6 more
TLDR
An applicable and evidence-based, step by step, decision pathway for the diagnosis and treatment of acute ankle injuries is presented, which can be implemented in any emergency department or doctor's practice and provides quality assurance for the patient and promotes confidence in the attending physician.Abstract:
Acute ankle injuries are among the most common injuries in emergency departments. However, there are still no standardized examination procedures or evidence-based treatment. Therefore, the aim of this study was to systematically search the current literature, classify the evidence, and develop an algorithm for the diagnosis and treatment of acute ankle injuries. We systematically searched PubMed and the Cochrane Database for randomized controlled trials, meta-analyses, systematic reviews or, if applicable, observational studies and classified them according to their level of evidence. According to the currently available literature, the following recommendations have been formulated: i) the Ottawa Ankle/Foot Rule should be applied in order to rule out fractures; ii) physical examination is sufficient for diagnosing injuries to the lateral ligament complex; iii) classification into stable and unstable injuries is applicable and of clinical importance; iv) the squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis; v) magnetic resonance imaging is recommended to verify injuries of the syndesmosis; vi) stable ankle sprains have a good prognosis while for unstable ankle sprains, conservative treatment is at least as effective as operative treatment without the related possible complications; vii) early functional treatment leads to the fastest recovery and the least rate of reinjury; viii) supervised rehabilitation reduces residual symptoms and re-injuries. Taken these recommendations into account, we present an applicable and evidence-based, step by step, decision pathway for the diagnosis and treatment of acute ankle injuries, which can be implemented in any emergency department or doctor's practice. It provides quality assurance for the patient and promotes confidence in the attending physician.read more
Citations
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The use of ice in the treatment of acute soft tissue injury: A systematic review of randomized controlled trials.
TL;DR: In this paper, a systematic review assessing the evidence base for cryotherapy in the treatment of acute soft-tissue injuries was carried out up to April 2002, with a mean PEDro score of 3.4 out of 10.
Journal ArticleDOI
Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline
Gwendolyn Vuurberg,Gwendolyn Vuurberg,Gwendolyn Vuurberg,Alexander Hoorntje,Alexander Hoorntje,Alexander Hoorntje,Lauren M. Wink,Lauren M. Wink,Brent F W van der Doelen,Brent F W van der Doelen,Brent F W van der Doelen,Michel P.J. van den Bekerom,Rienk Dekker,C. Niek van Dijk,C. Niek van Dijk,C. Niek van Dijk,Rover Krips,Masja Loogman,Milan L Ridderikhof,Frank F Smithuis,Sjoerd A.S. Stufkens,Evert Verhagen,Evert Verhagen,Rob A. de Bie,Gino M. M. J. Kerkhoffs,Gino M. M. J. Kerkhoffs,Gino M. M. J. Kerkhoffs +26 more
TL;DR: This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies.
Journal ArticleDOI
Injuries to the Ankle Syndesmosis
Tyler Van Heest,Paul M. Lafferty +1 more
TL;DR: Intraoperative three-dimensional radiography and direct syndesmotic visualization can improve rates of anatomic reduction and the so-called gold-standard syndesmosis screw fixation is being brought increasingly into question.
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Management and prevention of acute and chronic lateral ankle instability in athletic patient populations.
TL;DR: Prophylactic bracing and combined neuromuscular and proprioceptive training programs have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.
Journal ArticleDOI
Management of acute whiplash: A randomized controlled trial of multidisciplinary stratified treatments
TL;DR: It was showed that multiprofessional stratified management had no effect beyond usual care in reducing transition rates to chronicity in patients with acute whiplash, suggesting that future research focus on finding early effective pain management, particularly for the subgroup of patients with initial high levels of pain and disability, towards improving recovery rates.
References
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Journal ArticleDOI
A systematic review on ankle injury and ankle sprain in sports.
TL;DR: In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury.
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The frequency of injury, mechanism of injury, and epidemiology of ankle sprains.
TL;DR: In spite of these rather heroic measures, ankle injuries continue to constitute a significant threat to athletes in these and most other activities.
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A study to develop clinical decision rules for the use of radiography in acute ankle injuries
Ian G. Stiell,Gary H. Greenberg,R. Douglas McKnight,Rama C. Nair,Ian McDowell,James Worthington +5 more
TL;DR: Highly sensitive decision rules have been developed and will now be validated; these may permit clinicians to confidently reduce the number of radiographs ordered in patients with ankle injuries.