Title : Assisting in diagnosis of acute achilles tendon traumatic injury in emergency patients
Abstract:
Background: Achilles tendon ruptures are commonly misdiagnosed in emergency departments, leading to delayed treatment and prolonged rehabilitation. Advanced imaging (ultrasound/MRI) is the gold standard but is often unavailable outside routine hours.
Methods: We conducted a retrospective study over 5 months (May 2021–May 2024) including 109 patients presenting with suspected Achilles tendon rupture to a single emergency department. Lateral ankle X-rays were reviewed by two radiologists specifically for disruption of Kager's triangle. MRI or ultrasound served as the reference standard. Outcomes included diagnostic correlation and length of stay (LOS).
Results: Disruption of Kager's triangle on lateral ankle X-ray correlated with confirmed Achilles tendon rupture in 75% of cases. Mean LOS was 1.26 days. Trauma accounted for 69.8% of injuries, with a male predominance (82.7%). X-rays were used in 62.3% of cases, while ultrasound (17.3%) and MRI (1.2%) were reserved for complex or equivocal presentations. A significant correlation was observed between X-ray and MRI findings (P < 0.05).
Conclusion: Lateral ankle X-ray with focused assessment of Kager's triangle is a practical adjunct to clinical examination for diagnosing acute Achilles tendon ruptures in emergency settings when advanced imaging is unavailable. It should be used alongside clinical assessment, with confirmation by ultrasound or MRI when possible.
