The role of computed tomography with external rotation and dorsiflexion in decision making for acute isolated non-displaced posterior malleolar fractures Bartoníček and Rammelt type II: a prospective study.

Autor: Godoy-Santos AL; Lab. Prof. Mario Manlio Marco Napoli, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil. alexandrelemegodoy@gmail.com.; Locomotor Program, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, SP, 05652-900, Brazil. alexandrelemegodoy@gmail.com.; Department of Orthopaedic Surgery, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil. alexandrelemegodoy@gmail.com., Rodrigues JC; Department of Imaging Diagnostic, Hospital Israelita Albert Einstein, São Paulo, Brazil., Barros-Santos D; Department of Imaging Diagnostic, Hospital Israelita Albert Einstein, São Paulo, Brazil., de Cesar Netto C; Department of Orthopedic Surgery, Duke University, Durham, NC, USA., Mansur NSB; Department of Orthopaedic and Rehabilitation, University of Iowa, Carver College of Medicine, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA., de Carvalho KAM; Department of Orthopaedic and Rehabilitation, University of Iowa, Carver College of Medicine, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA., Giordano V; Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro, 117, Rio de Janeiro, RJ, 22430-160, Brazil.; Clínica São Vicente, Rede D'or São Luiz, R. João Borges, 204, Rio de Janeiro, RJ, 22451-100, Brazil., Rammelt S; Universitäts Centrum Für Orthopädie Und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Dresden, Germany.
Jazyk: angličtina
Zdroj: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie [Eur J Orthop Surg Traumatol] 2024 Oct; Vol. 34 (7), pp. 3743-3751. Date of Electronic Publication: 2024 Apr 22.
DOI: 10.1007/s00590-024-03952-4
Abstrakt: Purpose: Our objective was to evaluate the syndesmotic and fracture instability using conventional ankle computed tomography (CT) with stress maneuvers.
Methods: A consecutive sample of 123 individuals with an ankle sprain was assessed for eligibility. In total, 33 patients met the inclusion criteria. All patients underwent a magnetic resonance imaging (MRI) and CT scan with stress maneuvers (CTSM). The patterns of ligament tears f were classified using West Point grades I, IIA, IIB, III. Mann-Whitney test was used to test the differences in the numerical variables between injured and uninjured syndesmoses. The Spearman correlation tested the strength of the association between the tibial joint surface involved in posterior malleolus fracture and syndesmotic instability.
Results: In MRI, two patterns of syndesmotic ligament injury predominated. A completely torn anterior inferior tibiofibular (AITFL) and interosseous tibiofibular ligaments (ITFL) and a completely torn AITFL were combined with a partially torn ITFL. In the neutral phase CTSM and during the stress phase the median difference of the narrowest tibiofibular distance between injured and uninjured syndesmoses was 0.2 mm (P = 0.057) and 2.3 mm (P < 0.0001), respectively. There was no association between the percentage of involvement of the posterior tibial joint surface in the posterior malleolar fracture and syndesmotic instability as measured with CTSM.
Conclusion: The conventional computed tomography with external rotation and dorsiflexion represents a reproducible and accurate diagnostic option for detecting syndesmosis instability and fracture instability in acute isolated non-displaced posterior malleolar fractures Bartoníček and Rammelt type II.
Level of Evidence: Prospective study among consecutive patients (Diagnosis); Level of evidence, 2.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
Databáze: MEDLINE
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