Magnetic Resonance Imaging Has Utility in Clinical Decision-Making for Children and Adolescents With Symptomatic Subfibular Ossicles.

ABSTRACT

Treatment of children with chronic ankle pain, lateral instability, and the presence of a subfibular ossicle (SO) can be challenging. When will these patients respond to nonoperative management, and when will they require surgery? The purpose of this study was to investigate the utility of magnetic resonance imaging (MRI) in clinical decision-making for patients with symptomatic SOs. METHODS: We performed a retrospective study of pediatric patients with lateral ankle pain, recurrent sprains, and radiographs showing SOs who had undergone an MRI as part of their diagnostic work-up. We identified 22 patients from the senior author's registry of pediatric patients with lateral ankle injuries. Eleven were girls, and 11 were boys, ages ranging from five to 19 years. Eleven involved the left ankle; 11 involved the right. Positive MRIs showed a high-intensity signal between the SO and the distal fibular epiphysis; negative MRIs had a low-intensity signal. The main outcome measure was operative versus non-operative treatment. RESULTS:  Sixteen of the 22 patients had positive MRIs, and six had negative MRIs. Twelve of the 16 patients with positive MRIs had undergone an operation. All six patients with negative MRIs responded to nonoperative management. CONCLUSIONS: MRI has utility in clinical decision-making for symptomatic patients with SOs. Patients with negative MRI sequences responded to nonoperative management. Most patients with positive MRI sequences will require surgery to alleviate their symptoms and return to full activities. LEVEL OF EVIDENCE IV.