Incidence of Nonindicated and Inadequate Ankle Stress Views

Ankle stress view (ASV) radiographs and medial clear space (MCS) are important components for determining operative fixation of ankle fractures but variability in the appropriate use of indications and radiograph quality has yet to be thoroughly investigated. This is a case series of 130 patients who sustained an ankle fracture between 2012 and 2019. ASV radiographs were indicated for isolated Weber B fracture types with MCS < 4 mm on mortise views. Patient demographics, appropriate indications, adequacy of radiographs, and operative management were recorded. A MCS value of 4.9 mm served as our institution’s operative threshold (area under the curve: 0.60, 95% confidence interval: 0.95 – 0.79). It was found that 36 of 130 (27%) patients had an ASV that was not indicated, and 40 of 130 (30%) had an ASV that was of inadequate quality. Notably, of the 40 patients with inadequately performed stress views, 24 (60%) underwent surgical intervention. Only 51% of ASV radiographs were appropriately indicated and adequately performed. (Journal of Surgical Orthopaedic Advances 35(2):103–106, 2026) Key words: ankle stress view, medial clear space (MCS), Danis-Weber, Medial malleolus