Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department

Lowri, Bowen; Rhodri, Evans; Bodger, Owen; Joshua, Howard; Anne-Marie, Hutchison

doi:10.23937/2643-3885/1710033

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Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department

Bowen Lowri, Evans Rhodri, Owen Bodger

, Howard Joshua, Hutchison Anne-Marie

International Journal of Foot and Ankle, Volume: 3, Issue: 2

Swansea University Author: Owen Bodger

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DOI (Published version): 10.23937/2643-3885/1710033

Abstract

AimsTo investigate the diagnostic validity of four radiological soft tissue signs Kager's sign (K), disruption to the tendon (D), loss of parallelism (P) and fusiform swelling of the tendon (F) on a lateral ankle x-ray to aid Achilles tendon rupture diagnosis.MethodsWe retrospectively identifie...

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Published in:	International Journal of Foot and Ankle
ISSN:	2643-3885
Published:	ClinMed International Library 2019
Online Access:	Check full text
URI:	https://cronfa.swan.ac.uk/Record/cronfa61628

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spelling	2022-11-09T10:52:41.3884742 v2 61628 2022-10-20 Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department 8096440ab42b60a86e6aba678fe2695a 0000-0002-4022-9964 Owen Bodger Owen Bodger true false 2022-10-20 MEDS AimsTo investigate the diagnostic validity of four radiological soft tissue signs Kager's sign (K), disruption to the tendon (D), loss of parallelism (P) and fusiform swelling of the tendon (F) on a lateral ankle x-ray to aid Achilles tendon rupture diagnosis.MethodsWe retrospectively identified two groups of patients; Group A consisted of patients with an Achilles tendon rupture and Group B included patients with a clinically intact Achilles tendon but with a lateral ankle ligament sprain. Three clinicians independently reviewed all patients' x-rays for each of the radiological features under investigation to determine whether a rupture was present or not. Inter-rater and Intra-rater reliability were calculated using the Kappa coefficient (Kc.) To determine the predicted value of the signs sensitivity, specificity, positive predicted values and negative predicted values were calculated.Results85 patients x-rays were included in this study; Group A n = 47, Group B n = 38. The most valid radiological sign appeared to be loss of parallelism (sensitivity 70%, specificity 97%, kappa 0.55-0.58).ConclusionClinicians reviewing a lateral ankle x-ray of a patient with an acute ankle injury should review the x-ray for loss of parallelism between the tendon and skin; identification of this radiological sign may alert the clinician to the possible diagnosis of a ruptured Achilles tendon. Reviewing this may reduce the number of missed Achilles ruptures. Journal Article International Journal of Foot and Ankle 3 2 ClinMed International Library 2643-3885 Achilles tendon, Rupture, Diagnosis, X-ray, Ankle injury 14 9 2019 2019-09-14 10.23937/2643-3885/1710033 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University This research received no specific grant from any funding agency in the public, commercial or not-forprofit sectors. 2022-11-09T10:52:41.3884742 2022-10-20T14:58:58.4423424 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Bowen Lowri 1 Evans Rhodri 2 Owen Bodger 0000-0002-4022-9964 3 Howard Joshua 4 Hutchison Anne-Marie 5 61628__25707__4d1c629bf9f44394b1cfde8d7f408388.pdf 61628_VoR.pdf 2022-11-09T10:50:16.2750925 Output 746714 application/pdf Version of Record true Copyright: © 2019 Bowen L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License true eng https://creativecommons.org/licenses/by/4.0/
title	Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department
spellingShingle	Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department Owen Bodger
title_short	Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department
title_full	Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department
title_fullStr	Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department
title_full_unstemmed	Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department
title_sort	Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department
author_id_str_mv	8096440ab42b60a86e6aba678fe2695a
author_id_fullname_str_mv	8096440ab42b60a86e6aba678fe2695a_***_Owen Bodger
author	Owen Bodger
author2	Bowen Lowri Evans Rhodri Owen Bodger Howard Joshua Hutchison Anne-Marie
format	Journal article
container_title	International Journal of Foot and Ankle
container_volume	3
container_issue	2
publishDate	2019
institution	Swansea University
issn	2643-3885
doi_str_mv	10.23937/2643-3885/1710033
publisher	ClinMed International Library
college_str	Faculty of Medicine, Health and Life Sciences
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hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
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hierarchy_parent_title	Faculty of Medicine, Health and Life Sciences
department_str	Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description	AimsTo investigate the diagnostic validity of four radiological soft tissue signs Kager's sign (K), disruption to the tendon (D), loss of parallelism (P) and fusiform swelling of the tendon (F) on a lateral ankle x-ray to aid Achilles tendon rupture diagnosis.MethodsWe retrospectively identified two groups of patients; Group A consisted of patients with an Achilles tendon rupture and Group B included patients with a clinically intact Achilles tendon but with a lateral ankle ligament sprain. Three clinicians independently reviewed all patients' x-rays for each of the radiological features under investigation to determine whether a rupture was present or not. Inter-rater and Intra-rater reliability were calculated using the Kappa coefficient (Kc.) To determine the predicted value of the signs sensitivity, specificity, positive predicted values and negative predicted values were calculated.Results85 patients x-rays were included in this study; Group A n = 47, Group B n = 38. The most valid radiological sign appeared to be loss of parallelism (sensitivity 70%, specificity 97%, kappa 0.55-0.58).ConclusionClinicians reviewing a lateral ankle x-ray of a patient with an acute ankle injury should review the x-ray for loss of parallelism between the tendon and skin; identification of this radiological sign may alert the clinician to the possible diagnosis of a ruptured Achilles tendon. Reviewing this may reduce the number of missed Achilles ruptures.
published_date	2019-09-14T05:20:27Z
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score	11.3749895

Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department

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