THE RELEVANCE OF HEARING A CRACK IN ANKLE INJURIES

Objective-To examine the predictive value of a crack noise or sensatio n in the history of injury in the diagnosis of ankle fracture. Methods -A short questionnaire was filled in on 464 patients with isolated ank le injuries attending the accident and emergency department in a three month period from July to September. These patients were seen in the usual way in the department and the need for x ray assessed according to clinical judgement and existing departmental guidelines. Cases whic h subsequently proved to be other than ankle injuries, for example, fr actured calcaneus, were excluded from the study. Results-A positive hi story of hearing or feeling a crack did not indicate the need for an x ray or increase the possibility of a fracture; indeed the history of a crack made the presence of a fracture less likely. The clinical diag nosis of absence of fracture without radiological examination may requ ire careful explanation to the patient. Conclusions-Hearing a crack in the ankle does not suggest a fracture.