Journal article
Results of a Computed Tomography Protocol Evaluating Distal Third Tibial Shaft Fractures to Assess Noncontiguous Malleolar Fractures
The journal of trauma, v 71(1), pp 163-168
Jul 2011
PMID: 21818022
Abstract
Background: Intra-articular tibia fractures are reported to occur in 1% to 25% of tibia diaphyseal fractures. The objective of this study was to create a standard protocol to evaluate noncontiguous malleolar fractures associated with distal third tibial diaphyseal fractures using computed tomography (CT).
Methods: Sixty-six patients with 67 distal third tibia fractures were treated at a level one trauma center from December 2005 to November 2007. These patients were then evaluated using a CT protocol to assess the ankle joint. There were 45 men and 21 women with average age of 44 years (range 18-69 years). All films were independently examined by two orthopedic traumatologists and one musculoskeletal radiologist.
Results: Twenty-nine of 67 (43%) distal third tibial shaft fractures had associated intra-articular fractures determined by CT scan. There were 23 posterior malleolus fractures, 3 anterolateral fragments, and 3 medial malleolus fractures. Twenty-seven of 29 fractures (93%) were associated with spiral type fracture patterns (p = 0.001). Seventeen of 29 (59%) intra-articular fractures required operative fixation. Seventy-six percent were noncontiguous fractures. The radiologist detected 20 of 29 (69%) intra-articular fractures using high-resolution monitors, and the orthopedic surgeons averaged 13 of 29 (45%) using initial injury radiographs in the emergency department.
Conclusion: Plain radiographs are often insufficient for detecting posterior malleolus fractures in conjunction with ipsilateral distal third diaphyseal tibia fractures. Using a preoperative CT protocol for tibial shaft fractures can significantly improve the ability to diagnose associated intra-articular fractures that may not be evident on plain radiographs. Knowledge of these associated intra-articular fractures may prompt fracture stabilization and can prevent displacement during intramedullary nailing of tibia shaft fractures.
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Details
- Title
- Results of a Computed Tomography Protocol Evaluating Distal Third Tibial Shaft Fractures to Assess Noncontiguous Malleolar Fractures
- Creators
- Gregory J. Purnell - Allegheny General HospitalEricka R. Glass - Allegheny General HospitalDaniel T. Altman - Allegheny General HospitalRobert L. Sciulli - Allegheny General HospitalMatthew T. Muffly - Allegheny General HospitalGregory T. Altman - Allegheny General Hospital
- Publication Details
- The journal of trauma, v 71(1), pp 163-168
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Orthopedic/Orthopaedic Surgery
- Web of Science ID
- WOS:000292607400037
- Scopus ID
- 2-s2.0-79960407114
- Other Identifier
- 991021897406104721
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Critical Care Medicine
- Surgery