Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2023; 14(12): 868-877
Published online Dec 18, 2023. doi: 10.5312/wjo.v14.i12.868
Importance of computed tomography in posterior malleolar fractures: Added information to preoperative X-ray studies
Noé De Marchi Neto, Pietro Felice Tomazini Nesello, Jordanna Maria Bergamasco, Marco Tulio Costa, Ralph Walter Christian, Nilson Roberto Severino
Noé De Marchi Neto, Pietro Felice Tomazini Nesello, Jordanna Maria Bergamasco, Marco Tulio Costa, Ralph Walter Christian, Nilson Roberto Severino, Department of Orthopedics and Traumatology of the São Paulo Mercy Hospital (Santa Casa de São Paulo)-Fernandinho Simonsen Pavillion, Faculdade de Ciências Médicas da Santa Casa de São Paulo-Brazil, São Paulo 01221-020, Brazil
Author contributions: De Marchi Neto N, Christian RW and Severino NR contributed to conceptualization; De Marchi Neto N and Nesello PFT contributed to methodology; De Marchi Neto N and Nesello PFT contributed to formal analysis and investigation; De Marchi Neto N and Nesello PFT contributed original draft preparation and figures; Bergamasco JMP and Costa MT contributed reviewing and editing; Christian RW and Severino NR contributed to supervision.
Institutional review board statement: Institutional review board statement: This study protocol was reviewed and approved by the Bioethics Committee of the authors’ institution (5.117.984).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Noé De Marchi Neto, MSc, Instructor, Surgeon, Department of Orthopedics and Traumatology of the São Paulo Mercy Hospital (Santa Casa de São Paulo)-Fernandinho Simonsen Pavillion, Faculdade de Ciências Médicas da Santa Casa de São Paulo-Brazil, Cesário Motta Junior Street, 61, São Paulo 01221-020, Brazil. noedemarchineto@gmail.com
Received: July 12, 2023
Peer-review started: July 12, 2023
First decision: August 31, 2023
Revised: September 18, 2023
Accepted: October 16, 2023
Article in press: October 16, 2023
Published online: December 18, 2023
Processing time: 155 Days and 10.1 Hours
Abstract
BACKGROUND

Ankle fractures are common lesions of the lower limbs. Approximately 40% of ankle fractures affect the posterior malleolus (PM). Historically, PM osteosynthesis was recommended when PM size in X-ray images was greater than 25% of the joint. Currently, computed tomography (CT) has been gaining traction in the preoperative evaluation of ankle fractures.

AIM

To elucidate the similarity in dimensions and to correlate PM size in X-ray images with the articular surface of the affected tibial plafond in the axial view on CT (AXCT) of a PM fracture.

METHODS

Eighty-one patients (mean age: 39.4 ± 13.5 years) were evaluated (54.3% were male). Two independent examiners measured PM size in profile X-ray images (PMXR) and sagittal CT (SAGCT) slices. The correlation of the measurements between the examiners and the difference in the PM fragment sizes between the two images were compared. Next, the PM size in PMXR was compared with the surface of the tibial plafond involved in the fracture in AXCT according to the Haraguchi classification.

RESULTS

The correlation rates between the examiners were 0.93 and 0.94 for PMXR and SAGCT, respectively (P < 0.001). Fragments were 2.12% larger in SAGCT than in PMXR (P = 0.018). In PMXR, there were 56 cases < 25% and 25 cases ≥ 25%. When PMXR was < 25%, AXCT corresponded to 10.13% of the tibial plafond. When PMXR was ≥ 25%, AXCT was 24.52% (P < 0.001). According to the Haraguchi classification, fracture types I and II had similar PMXR measurements that were greater than those of type III. When analyzing AXCT, a significant difference was found between the three types, with II > I > III (P < 0.001).

CONCLUSION

PM fractures show different sizes using X-ray or CT images. CT showed a larger PM in the sagittal plane and allowed the visualization of the real dimensions of the tibial plafond surface.

Keywords: Ankle fracture, Posterior malleolar fracture, Computed tomography, X-ray, Posterior malleolus fracture, Trimalleolar facture

Core Tip: The study showed fractures of the posterior malleolus (PM) were different sizes on X-ray and computed tomography (CT) images. It is possible to see that some PM patterns considered small on radiographs affected a significant joint area when CT scans were performed. CT scans also showed that the actual size of the PM fragment was larger than that seen on radiographs.