What Are the Benefits of X-Rays in Medicine

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Table of Contents

Introduction
Symptoms
Diagnosis
Radiology
Treatment
Conclusion

Introduction

The ankle is among the sites that are most affected by acute musculoskeletal injuries. Anankle sprains make up 75 percent of these injuries. Intense trauma of the ankle is common in athletes. Sports injuries are composed of at least 10% – 30% ankle trauma. The number of people who consult physicians per annum with acute ankle injuries is estimated to be about one million people. About a half of sprains that occur in patients can potentially result in chronic health problems (Nieman2009). The most vulnerable part of the ankle is the joint connecting the lower leg with the foot. This joint is affected by a number of exposures, which include twisting, unusual pressure, etc. These injuries may happen while one is walking, running, in athletics or even as one engages in day-to-day activities (Nieman2009).

There are three bones in, the ankle joint. The major one is called the tibia. This bone carries the largest percentage of a person’s body weight. Its bottom part is referred to as the medial malleolus. This is the internal bump in the ankle. Tibia’s smaller counterpart is referred to as the fibula. Its bottom end which is seen as the outer bump is referred to as the lateral malleolus. The top bone in the foot is called the talus. Bones and muscles are joined together by connective tissues known as tendons. Body motion, including that of the ankle, is facilitated by muscles. The muscles that form part of the ankle are therefore connected to the bones of the foot by tendons. These can easily get torn or stretched. This normally happens when they are under intense stress. They can also be separated from the bone if the stress is too much. Achilles tendon rupture is a good example of this type of injury. Bones are connected by ligaments. If ligaments have been strained, the resulting injury has termed a sprain (Assal and Crevoisier 2009, 1551). The ankle is made up of a number of bones and thus it is composed of several ligaments. They can also get torn or stretched in intense stress like the tendons. The ligament that is most affected by injury is known as the anterior talofibular ligament. Its function is to connect the fibula to the talus. It, therefore, forms the front part of the external ankle joint.

The complicatedness of an ankle sprain can be categorized by grade I to III. If the ligament is partially torn, the sprain is classified as grade I. This can be diagnosed by symptoms like mild swelling and tenderness, mechanical stability, and absence of functional loss. Grade I sprain is normally exhibited by calcaneofibular ligament stretching and anterior talofibular ligament stretching (Ivins 2006, 1714).

Grade II sprain is said to occur if the ligament gets torn partially leading to moderate functional impairment. This is diagnosed by moderate swelling and pain, tenderness over the structures that are involved in the sprain, mild or moderate ecchymosis, some degree of function and motion loss (i.e. pain with ambulation and weight-bearing), and moderate or mild instability. In this injury, one ligament is torn while another is stretched. The first is the anterior talofibular ligament while the second is the calcaneofibular ligament (Ivins 2006, 1714).

Grade III sprain occurs when a ligament is completely torn, making it lose its integrity. This is diagnosed by extensive swelling, severe ecchymosis, function and motion loss (i.e., inability to ambulate or bear weight), and mechanical instability. In Grade III sprain, the calcaneofibular ligaments and the anterior talofibular ligaments are ruptured (Ivins 2006, 1714).

In terms of treatment, the sprains can be classified into complicated and uncomplicated sprains. The uncomplicated ones can be treated without surgical interventions. These are the injuries that do not affect early motion and rehabilitation – i.e. those that do not cause concomitant problems (Quinn 2007). Complicated sprains have to be treated using surgery. It is important to note that both surgery and non-operative treatment may cause late instability. Late reconstruction is normally effective when used on patients who were initially treated without being operated on.

Symptoms

If the ligament is excessively stretched, its tear is extensive and thus the patient is likely to feel a lot of pain. Instability occurs in cases where the ligament is completely torn, or when the ankle joint is completely dislocated (Assal and Crevoisier 2009, 1552). In addition to the ligament pain, several other symptoms may occur. These include swelling, which is a result of an increase in tissue fluid, sensitive nerves that may also cause pain, and warm redness that is caused by an increase in blood flow to the injured area (Collins 2003, 186).

Diagnosis

The first step in ankle sprain diagnosis is a physical examination that is aimed at checking if a serious injury like a fracture has occurred. This helps in determining if the patient requires immediate care (Collins 2003, 186). The aforementioned physical examination should ensure that the other parts of the leg are not involved. The doctor normally holds and moves the ankle and the foot to check the bony areas that are involved. He/she also checks if the Achilles tendon is ruptured. After these checks, an X-ray is performed on the patient to get the best diagnosis for the patient (Doherty and Way 2006, 802).

Radiology

X-ray is vital in the emergency department because it is used in detecting ankle sprains, pain in the area surrounding the malleolus, and other issues like:

Tenderness of the posterior side of the fibula or the lateral malleolus tip.
Tenderness of the posterior side of the tibia or the medial malleolus tip (Doherty and Way 2006, 802).

In examining sprains of the ankle, a radiologist ensures that he/she has three views of the same. These are the Mortise-view, lateral view, and anteroposterior view. The first is termed as the oblique view while the last is abbreviated as the AP view. The examiner first takes three different pictures of the ankle. On an AP view, the talus normally appears above a section of the lateral malleolus, making the lateral ankle joint invisible

The AP view is such that the two bumps (malleoli) are visible. The Mortise-view is essentially a slight rotation of the aforementioned AP-view. To get the view, therefore, the examiner turns the foot inwards and aligns the medial malleolus with the lateral malleolus

This means that the view captures the spaces created by the medial and lateral parts of the joint. A fracture, together with a rupture of ligaments can cause instability. Apart from instability, rupture of ligaments can be confirmed if the ankle mortise becomes wide

The clear space in the medial malleolus should not be more than 4 mm. It normally has the same measurement as the space between the talus and the tibial plafond (Doherty and Way 2006, 215). If it widens up to or past 6 mm, then the medial collateral ligament becomes disrupted (Press, Gupta and Hutchinson 2009, 228). Syndesmotic rupture means that the clear space in the lateral position is wider than usual. To determine this one measure between the fibula’s central border and the bottom tibia border. While taking this measurement, a distance of 1cm is maintained from the tibial plafond. The images may therefore show fractures in the malleolus, fractures in the talar dome, or syndesmosis of the ankle. If the examiner finds the patient with any of these, he/she should refer the patient to an orthopedic specialist.

In case the plain ankle X-ray is negative, or if the ankle joint has abnormalities or stress fracture, it may be necessary to conduct a CT scan on the fractured joint. If the fractured part of the posterior malleolus is due to ankle sprains, then a CT scan may be necessary in estimating how long the fracture fragment is.

The patient may feel tenderness in the injured ligament. If the patient has no broken bone, then the radiographer can use the extent of swelling, degree of pain and even the extent of bruising to gauge the grade of the ankle sprain. The patient is likely to feel pain during this physical examination. This is because the radiographer may need to view the ankle in different positions. Complete ligament tearing renders the patient unstable with time. In this case, there is a possibility of the ankle joint surface getting damaged by the injury. This usually requires the use of MRI in order to diagnose the rupture of the ligament. MRI is also used on suspicion of joint surface injury, severe ligament injury, a chip of a small bone, etc. The diagnosis of the MRI is usually accurate. MRI may therefore be carried out after the ankle stops swelling and bruising.

Finally, when ankle pains persist for a period exceeding six weeks, a MRI or CT-scan should be carried out to check if the patient could be having talar dome lesions. MRI or CT-scans should also be carried out on patients with crepitus or catching injuries. The scans are crucial in ensuring that the osteochondral fragments are not displaced.

Treatment

There are two stages for treating sprains. The initial objective is pain and swelling reduction. This is done during the initial stage of treatment. During this stage, patients are advised to “follow a formula of rest, ice, compression and elevation (RICE)” (Nieman 2009) one to two days after the occurrence of injury. Patients may also be prescribed to use a non-steroidal anti-inflammatory over-the-counter drug to help in reducing inflammation and pain. Examples include ibuprofen and aspirin (Nieman 2009). A hard cast may be necessary for patients with a sprain ranging from moderate to severe. However, the casting has to wait until the swelling reduces. Severe strains and sprains may need surgical operations. Orthopaedic surgeons are needed for the operations. This therefore necessitates the evaluation of severe strains and sprains by a professional healthcare provider in order to allow prompt and appropriate treatment (Quinn 2007).

Conclusion

X-rays are instrumental in confirming diagnosis when a patient experiences tenderness, deformity etc. The X-ray comes in handy in case the patient’s bones are broken or if the patient’s joints are dislocated. During alignment, X-ray guides how bones will be moved. It can also help in determining whether the patient is healed. In case surgery is necessary, an X-ray can be used to plan it. After the procedure, an X-ray can also be used to check if the operation has been conducted successfully. X-ray is also instrumental in detecting other abnormalities like cysts, tumours, etc. X-ray, MRI and CT-scans are therefore vital in ankle sprain diagnosis.

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