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Computed tomography changes diagnosis, management and surgical planning of ankle fractures

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MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Purpose

To demonstrate how the use of adjunctive Computed Tomography (CT) can modify diagnosis, treatment options, and operative planning of ankle fractures in comparison with conventional radiographs (CR) in isolation.

Materials and methods

A total of 53 patients diagnosed with an ankle fracture between 2011 and 2016, were assessed with CT and CR. Evaluations of the fractures using CR in isolation and CR combined with CT were compared using different readers. Fractures were assessed in terms of type, displacement, size, associated injuries, treatment, patient position and surgical planning.

Results

The medial malleolus fractures characteristics (posteromedial fragment and anterior colliculus), the presence of posterior malleolus fracture and its characteristics (displacement, size, posteromedial or posterolateral segment) (ps < 0.042), syndesmosis injury (p < 0.001), and the absence of deltoid ligament lesion (p < 0.001), were more evident with the combination of CT and radiographs. There was an increase in operative indication (p = 0.007), prone positioning (p = 0.002), posterior malleolus surgical treatment (p < 0.001), posterolateral approach for the lateral malleolus (p = 0.003), and syndesmosis fixation (p = 0.020) with the association of CT and CR, among all groups of expertise, with a high interobserver reliability (> 0.75).

Conclusions

The CR may fail to demonstrate subtle lesions, such as posterior malleolus fractures and syndesmotic injuries. The CT evaluation increases the diagnostic precision and improves the quality of information the surgeon receives, what might positively affect patient care.

Level of evidence III

Retrospective Comparative Study.

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Data availability

According to the ICMJE data sharing police, core records will be shared through Mendeley Data and available upon request.

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Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, 740 Botucatu St, 1st Floor, São Paulo, SP, 04023-062, Brazil

    N. S. B. Mansur, C. M. S. C. C. Neves, F. S. Celestino, J. P. P. Gonçalves, V. F. Pereira, P. D. V. Silva, F. T. Matsunaga, C. A. S. Nery & D. C. Astur

  2. Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

    N. S. B. Mansur, J. P. P. Gonçalves, P. D. V. Silva & C. A. S. Nery

  3. Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA

    N. S. B. Mansur

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Contributions

NSBM (Corresponding Author): had full access to all the data in the study and takes responsibility for the integrity and accuracy of the data analysis. Literature revision, study design, writing, paper submissions and data collecting. CMDSCCN: writing, data collecting, data analysis and paper submission. FSC: literature revision, data collecting, statistical analysis, writing. JPPG: literature revision, writing. VFP: reading, literature revision, writing. PDVS: reading, literature revision, writing. FTM: reading, literature revision, writing. CdASN: co-supervisor, literature revision, writing, study design and paper submissions. DCA: supervisor. Literature revision, writing, study design and paper submissions. Each author contributed to refinement of the study protocol and approved the final manuscript. Study conducted at the Department of Orthopedics and Rehabilitation, Paulista School of Medicine, Federal University of Sao Paulo.

Corresponding author

Correspondence to N. S. B. Mansur.

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Conflict of interest

Nacime Salomao Barbachan Mansur, MD, PhD: Brazilian Foot and Ankle Society: Board or committee member; American Orthopaedic Foot and Ankle Society: Board or committee member. Caio A Nery, MD, PhD: Acta Ortopedica Brasileira: Editorial or governing board; Arthrex, Inc: Paid consultant; Paid presenter or speaker; Foot and Ankle International: Editorial or governing board; Geistlich Biomaterials: Paid consultant; Paid presenter or speaker; Journal of the Foot and Ankle: Editorial or governing board; Revista Brasileira de Ortopedia e Traumatologia: Editorial or governing board; Wright Medical Technology, Inc.: Paid consultant. The other authors have nothing to disclosure. The cited companies did not finance the study or participate in any phase of its conduction. Implants used at this study were from several companies as the surgeries were performed at a public hospital. All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure and declare no support from any organization for the submitted work; Other authors have no financial relationships with any organizations that might have an interest in the submitted work in the previous ten years; no other relationships or activities that could appear to have influenced the submitted work.

Ethical approval

University Ethics Committee approved this research under the number 664330716.0.0000.0071 in accordance with the Declaration of Helsinki. The study complies with the Health Insurance Portability and Accountability Act (HIPAA).

Appendix

See Tables 3 and 4.

Table 4 Interobserver reliability by Kappa considering the combination of variables and single variables
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Mansur, N.S.B., Neves, C.M.S.C.C., Celestino, F.S. et al. Computed tomography changes diagnosis, management and surgical planning of ankle fractures. Musculoskelet Surg (2024). https://doi.org/10.1007/s12306-024-00814-4

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