Diagnosis of Ankle Injuries

To the Editor.—  In response to the letter of Allan W. March, MD (241:791, 1979), we appreciate the comments on our article, "Diagnosis of Ankle Injuries" (240:1182, 1978).There is no quarrel that the clinician should be sensitized to the possibility of complete ligamentous tear, considering the physical examination and findings March described. Our point was to sensitize the casual observer or one who accepts only the roentgenogram as presented to represent the entire diagnosis. Many persons reviewing cases of patients and roentgenograms in an emergency facility either do not recall the underlying soft-tissue structures or discount their presence. Therefore, our point was to encourage physical examination of the ankle as well as roentgenographic interpretation as an assist to the full diagnosis. Also, means were offered to substantiate the seriousness of what may appear to represent only a minor chip fracture.