Published online Dec 18, 2023. doi: 10.5312/wjo.v14.i12.868
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
For many decades when a posterior malleolus (PM) fracture was diagnosed, the size of the fragment on radiographs was always taken into consideration at the time of treatment. Therefore, fixation of the PM was recommended when greater than 25% of the tibial joint surface was involved.
This study aimed to see the real size of the PM fragment in ankle fractures and determine whether an X-ray image would be sufficient to show the real size of the fracture. It is also unknown if there is any correlation between PM size on X-rays and computed tomography (CT) scans.
To compare the PM size of the X-rays with the sagittal CT scans to see if they are similar and to evaluate the PM size compared with the axial CT scan and the articular surface of the tibial plafond involved in the ankle fracture.
Two foot and ankle specialists compared measurements of PM size on radiographs with CT scans. The PM size on the sagittal images and the joint surface area of the tibial plafond on the axial images were compared.
We found that PM fragments were 2.12% larger in sagittal CT than in X-rays. When analyzing axial CT scans, a significant difference was found between the three types of Haraguchi fractures.
PM fractures showed 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.
This study showed that CT is better to understand the size of the PM. Even small PM fractures on X-rays can affect a large portion of the articular surface. It would be recommended not to underestimate small PM fractures and always perform preoperative CT evaluation.