From the Guidelines
A repeat X-ray for your rolled right ankle should be performed in 7-10 days if your symptoms persist or worsen, especially if you continue to have pain and difficulty bearing weight. Your current X-ray shows a possible os trigonum (an extra bone that sometimes forms behind the talus) versus a potential fracture of the posterior talus. Since the radiologist recommended clinical correlation with the site of your pain, it's essential that your healthcare provider examines exactly where your ankle hurts to help determine the true nature of the injury 1.
Initial Assessment and Management
In the meantime, follow the RICE protocol:
- Rest your ankle
- Apply Ice for 15-20 minutes several times daily
- Use Compression with an elastic bandage
- Elevate your foot above heart level when possible. Take over-the-counter pain medications like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed for pain, unless contraindicated 1.
Monitoring for Complications
If your pain significantly worsens, you develop increased swelling, bruising, numbness, or inability to bear weight, seek immediate medical attention as these could indicate a more serious injury requiring additional imaging such as an MRI or CT scan to better visualize the bones and soft tissues 1. The decision for repeat imaging should be based on clinical judgment, considering the severity of symptoms and the initial radiographic findings.
Importance of Clinical Correlation
Clinical correlation is crucial in cases where the initial X-ray is inconclusive or suggests a possible fracture, as in your case with the probable os trigonum versus a less likely fracture of the posterior talus. The radiologist's recommendation for correlation with the site of pain underscores the need for a thorough clinical examination to guide further management 1.
Follow-Up and Further Evaluation
Given the information from the studies 1, it's clear that the approach to acute ankle trauma involves initial radiographs for patients meeting specific criteria, with further imaging considered based on persistent symptoms or specific findings on initial imaging. Your situation, with a possible os trigonum or posterior talus fracture, warrants close monitoring and potentially a repeat X-ray in 7-10 days if symptoms persist, aligning with the principles outlined in the provided evidence.
From the Research
Repeated X-Ray for Ankle Injury
The provided X-Ray report indicates a probable trigonometry versus less likely fracture of the posterior talus, with preserved joint spaces and no radiographically appreciable soft tissue abnormality.
- The report suggests correlation for the site of pain/tenderness is recommended, implying that further evaluation may be necessary to determine the extent of the injury.
- According to the study 2, CT scans are deemed necessary when radiographs show certain features, such as comminuted fracture of the medial malleolus or posterior malleolus, presence of loose bodies, or suspected Chaput or Volkman fracture fragment.
- However, the study 2 does not provide specific guidance on when to repeat an X-Ray for an ankle injury.
- The study 3 compares the accuracy of X-Ray imaging and CT scanning in the diagnosis of knee bone fractures and suggests that CT scanning should be performed when the fracture type and characteristics cannot be determined exactly with X-Ray imaging.
- Similarly, the study 4 compares CT scans and plain radiographs for detection of articular step and gap deformity after healing of operatively treated acetabular fractures and finds that CT scans are more likely to detect residual articular incongruities.
- There is no direct evidence in the provided studies to suggest when a repeated X-Ray is needed for an ankle injury with the given X-Ray report findings.
- The decision to repeat an X-Ray or proceed with further imaging, such as a CT scan, would depend on the clinical evaluation and correlation with the site of pain/tenderness, as recommended in the X-Ray report.