2017 ISAKOS Biennial Congress ePoster #118

 

Missed Fractures – The Role of Arthroscopy and a Routine CT Scan in Trimalleolar Fractures

Tomasz Szymanski, MD, Warszawa POLAND
Urszula E. Zdanowicz, MD, Warsaw POLAND
Robert Smigielski, MD, PhD, Warsaw, masovian POLAND
Michal Drwiega, MD, Warsaw POLAND
Beata Ciszkowska-Lyson, PhD, Warsaw POLAND
Przemyslaw P. Rychtik, MD, Warsaw POLAND

Carolina Medical Center, Warsaw, POLAND

FDA Status Not Applicable

Summary

: Awareness of complexity of malleolar fractures is still growing. Nowadays more often Experts postulate to diagnose this type of fractures based on CT in every single case, because of great risk of missed coexisting fractures. Also rutine arthroscopic control while operating on those fractures might reduce the risk of early osteoarthritis

Abstract

Purpose

The purpose of this study was to evaluate the acuracy of the diagnosis based on plain X-ray and to verify with CT scans.

Background

Awareness of complexity of malleolar fractures is still growing. Nowadays more often Experts postulate to diagnose this type of fractures based on CT in every single case, because of great risk of missed coexisting fractures. Also rutine arthroscopic control while operating on those fractures might reduce the risk of early osteoarthritis.

Materials And Methods

Between 2011-2015 there have been conducted a prospective research that included all patients reporting to the emergency department with the fracture of distal part of the tibia. Previous operations in this area were exclusion criteria. Finally, 40 patients (20 Men, 20 Women) were qualified to the research. All of patients had the X-rays of both ankles in a-p, lateral and in the mortise view as well as CT scan. The X-rays were analysed by a resident, an experienced orthopedic surgeon and musculo-skeletal radiologist. Further, we compared those results with CT scan results.

Resaults: In 25% of the patients additional fractures were overlooked if the assesment was based only on the x-rays, regardless who evaluated x-rays. In this group, the most frequently overlooked fractures were: Tillaux fracture, Volkmann's triangle fracture (especially the posterior-medial fragment), loose bodies in the joint, fracture of medial malleolus, intraarticular fractures, injuries of tibial-peroneal syndesmosis.

Discussion

Many Orthopedics Surgeons postulate to do CT scan in case doubts with evaluation plain X-ray. Analysis of the available literature and our own study resaults shows that, 25% of patients have a risk of underestimation level of damage of the ankle joint. Which cannot be detected neither treated with standard ORIF approach. Rutine CT scan and arthroscopic assisted treatment might prevent missing concomitant injuries as well as early osteoarthritis.