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World J Orthop. Mar 18, 2021; 12(3): 129-139
Published online Mar 18, 2021. doi: 10.5312/wjo.v12.i3.129
Advantages of preoperative planning using computed tomography scan for treatment of malleolar ankle fractures
Luigi Tarallo, Gian Mario Micheloni, Michele Mazzi, Arturo Rebeccato, Michele Novi, Fabio Catani
Luigi Tarallo, Gian Mario Micheloni, Michele Novi, Fabio Catani, Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, University of Modena and Reggio Emilia, Modena 41121, Italy
Michele Mazzi, Arturo Rebeccato, Dipartimento di Chirurgia, AULSS8 Berica-Ospedale San Bortolo-Vicenza, Vicenza 36100, Italy
Author contributions: All authors contributed equally to conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article and final approval of the version of the article.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luigi Tarallo, MD, Professor, Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, University of Modena and Reggio Emilia, Largo del Pozzo 71, Modena 41121, Italy. luigi.tarallo@unimore.it
Received: December 21, 2020
Peer-review started: December 21, 2020
First decision: January 7, 2021
Revised: January 7, 2021
Accepted: January 28, 2021
Article in press: January 28, 2021
Published online: March 18, 2021
Processing time: 80 Days and 12 Hours
Abstract

Malleolar ankle fractures have been classified using plain radiographs, and there is no consensus regarding the role of computed tomography (CT) scans in preoperative planning. We analyzed critical aspects, such as limits of standard radiographs, types of injury, classification methods and cost/benefit evaluations. CT scans allow a 3D analysis of the fracture to be obtained and consequently assess the indication for surgical procedure, surgical access and the type of fixation devices required. This exam is useful for detecting lesions that may go unnoticed on radiographs and will help surgeons to clarify the pathoanatomy of ankle fractures. According to Arbeitsgemeinschaft fur Osteosynthesefragen/ Orthopaedic Trauma Association (AO/OTA) classification, CT scan is recommended in medial malleolar fractures with vertical rim, type 44B fractures with posterior malleolar involvement and all type 44C fractures (according to AO/OTA). Also Tillaux-Chaput fractures (43-B1 according to AO/OTA), malleolar fractures in the presence of distal tibial fractures (43 according to AO/OTA) and distal tibia fractures in adolescents should be studied with CT scans.

Keywords: Computed tomography scan; Malleolar fractures; Planning; Trauma; Imaging

Core Tip: Computed tomography scan is recommended in medial malleolar fractures with vertical rim, type 44B fractures [according to Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification] with posterior malleolar involvement. All type 44C fractures (according to AO/OTA), Tillaux-Chaput fractures (43-B1 according to AO/OTA), malleolar fractures in the presence of distal tibial fractures (43 according to AO/OTA) and distal tibia fractures in adolescents should be studied with computed tomography scans.