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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.