Computed tomography changes diagnosis, management and surgical planning of ankle fractures.

Autor: Mansur NSB; Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, 740 Botucatu St, 1st Floor, São Paulo, SP, 04023-062, Brazil. nacimesbm@gmail.com.; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. nacimesbm@gmail.com.; Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA. nacimesbm@gmail.com., Neves CMSCC; Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, 740 Botucatu St, 1st Floor, São Paulo, SP, 04023-062, Brazil., Celestino FS; Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, 740 Botucatu St, 1st Floor, São Paulo, SP, 04023-062, Brazil., Gonçalves JPP; Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, 740 Botucatu St, 1st Floor, São Paulo, SP, 04023-062, Brazil.; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Pereira VF; Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, 740 Botucatu St, 1st Floor, São Paulo, SP, 04023-062, Brazil., Silva PDV; Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, 740 Botucatu St, 1st Floor, São Paulo, SP, 04023-062, Brazil.; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Matsunaga FT; Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, 740 Botucatu St, 1st Floor, São Paulo, SP, 04023-062, Brazil., Nery CAS; Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, 740 Botucatu St, 1st Floor, São Paulo, SP, 04023-062, Brazil.; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Astur DC; Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, 740 Botucatu St, 1st Floor, São Paulo, SP, 04023-062, Brazil.
Jazyk: angličtina
Zdroj: Musculoskeletal surgery [Musculoskelet Surg] 2024 Jun; Vol. 108 (2), pp. 183-194. Date of Electronic Publication: 2024 Mar 11.
DOI: 10.1007/s12306-024-00814-4
Abstrakt: Purpose: To demonstrate how the use of adjunctive Computed Tomography (CT) can modify diagnosis, treatment options, and operative planning of ankle fractures in comparison with conventional radiographs (CR) in isolation.
Materials and Methods: A total of 53 patients diagnosed with an ankle fracture between 2011 and 2016, were assessed with CT and CR. Evaluations of the fractures using CR in isolation and CR combined with CT were compared using different readers. Fractures were assessed in terms of type, displacement, size, associated injuries, treatment, patient position and surgical planning.
Results: The medial malleolus fractures characteristics (posteromedial fragment and anterior colliculus), the presence of posterior malleolus fracture and its characteristics (displacement, size, posteromedial or posterolateral segment) (ps < 0.042), syndesmosis injury (p < 0.001), and the absence of deltoid ligament lesion (p < 0.001), were more evident with the combination of CT and radiographs. There was an increase in operative indication (p = 0.007), prone positioning (p = 0.002), posterior malleolus surgical treatment (p < 0.001), posterolateral approach for the lateral malleolus (p = 0.003), and syndesmosis fixation (p = 0.020) with the association of CT and CR, among all groups of expertise, with a high interobserver reliability (> 0.75).
Conclusions: The CR may fail to demonstrate subtle lesions, such as posterior malleolus fractures and syndesmotic injuries. The CT evaluation increases the diagnostic precision and improves the quality of information the surgeon receives, what might positively affect patient care.
Level of Evidence Iii: Retrospective Comparative Study.
(© 2024. The Author(s), under exclusive licence to Istituto Ortopedico Rizzoli.)
Databáze: MEDLINE
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