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Jeon, Bae, Ahn, Chung, and Woo: Usefulness of Computed Tomography in Patients with Acute Malleolar Fracture
Original Article

J Korean Foot Ankle Soc 2015;19(4):156-160.

Published online: 10 January 2015

DOI: https://doi.org/10.14193/jkfas.2015.19.4.156

Usefulness of Computed Tomography in Patients with Acute Malleolar Fracture

Suk-Ha Jeon*, Su-Young Bae, Soo-Hyung Ahn, Hyung-Jin Chung, Seung-Hun Woo

Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

*Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea

Corresponding Author: Su-Young Bae Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: 82-2-950-1399, Fax: 82-2-950-1398, E-mail: youngos@paik.ac.kr

Received 14 October 2015       Revised 4 November 2015       Accepted 6 November 2015

Copyright © 2015 Korean Foot and Ankle Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We compared plain radiographs with computed tomography (CT) images to evaluate the usefulness of preoperative CT in acute ankle malleolar fracture in terms of accuracy of diagnosis and planning of operative strategy.

Materials and Methods

A retrospective analysis was conducted on 210 cases of malleolar fracture treated at our institute for which plain radiograph and CT were obtained preoperatively. Observers had reviewed plain radiographs and recorded fracture classification, anatomical diagnosis, extent and configuration of fractures and then subsequently reviewed CT images. Records from each image were compared and information regarding the differences in fractures was assessed.

Results

Fractures were notably changed in appearance in 88 cases (41.9%) and diagnosis changed in 30 cases (14.3%). According to the change of diagnosis and fracture appearances, the operative strategy was changed in 15 cases (7.1%) including incision, order of reduction, and target of fixation.

Conclusion

CT could be a useful adjunctive imaging tool in addition to the plain radiograph in planning of operative treatment for acute malleolar fracture in terms of estimating exact configuration, extent of fractures and even newly revealed hidden fractures.

Keywords: Ankle, Malleolar fracture, Computed tomography

References

1. Irwin TA, Lien J, Kadakia AR. Posterior malleolus fracture. J Am Acad Orthop Surg. 2013; 21:32–40.
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2. Phisitkul P, Ebinger T, Goetz J, Vaseenon T, Marsh JL. Forceps reduction of the syndesmosis in rotational ankle fractures: a cadaveric study. J Bone Joint Surg Am. 2012; 94:2256–61.
3. Magid D, Michelson JD, Ney DR, Fishman EK. Adult ankle fractures: comparison of plain films and interactive two- and three-dimensional CT scans. AJR Am J Roentgenol. 1990; 154:1017–23.
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4. Büchler L, Tannast M, Bonel HM, Weber M. Reliability of radiologic assessment of the fracture anatomy at the posterior tibial plafond in malleolar fractures. J Orthop Trauma. 2009; 23:208–12.
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5. Ferries JS, DeCoster TA, Firoozbakhsh KK, Garcia JF, Miller RA. Plain radiographic interpretation in trimalleolar ankle fractures poorly assesses posterior fragment size. J Orthop Trauma. 1994; 8:328–31.
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6. Haraguchi N, Haruyama H, Toga H, Kato F. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg Am. 2006; 88:1085–92.
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7. Black EM, Antoci V, Lee JT, Weaver MJ, Johnson AH, Susarla SM, et al. Role of preoperative computed tomography scans in operative planning for malleolar ankle fractures. Foot Ankle Int. 2013; 34:697–704.
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Figure 1.
(A) No definite posterior malleolus fracture was seen in plain radiograph. (B) Posterior malleolar fracture gap was revealed by computed tomography.
jkfas-19-156f1.tif
Figure 2.
(A) Other fracture line was missed by initial plain radiograph. (B) Additional Chaput tubercle fracture was found after reviewing the axial view of computed tomography image. (C) Chaput tubercle fragment was fixed with one 2.7 mm cortical screw.
jkfas-19-156f2.tif
Table 1.
Changes of Lauge-Hansen Classification after Reviewing Computed Tomography (CT) Images
Classification Plain radiograph only Plain radiograph +CT Case
SA I 10 6  
II 5 9 Stage I→II: 4 cases
SER I 0 0  
II 45 32  
III 3 4 Stage II→III: 1 case
IV 112 124 Stage II→IV: 12 cases
PA I 3 3  
II 1 1  
III 2 2  
PER I 0 0  
II 0 0  
III 8 3  
IV 10 15 Stage III→IV: 5 cases
Direct injury 11 11  
Total 210 210  

Values are presented as number of cases.

SA: supination-adduction, SER: supination-external rotation, PA: pronation-abduction, PER: pronation-external rotation.

Table 2.
Changes of Anatomic Diagnosis of Malleolar Fractures after Reviewing Computed Tomography (CT) Images
Diagnosis Plain radiograph only Plain radiograph+CT
Unimalleolar fracture    
 Medial 20 20
 Lateral 55 38
 Posterior 1 1
 Medial+lateral 16 7
Bimalleolar fracture    
 Medial+posterior 9 9
 Lateral+posterior 30 47
Trimalleolar fracture 79 88
Total 210 210

Values are presented as number of cases.

Table 3.
Additional Findings after Reviewing Computed Tomography (CT) Images
Additional finding Diagnosis Total
Lateral malleolar fracture Medial+lateral malleolar fracture Lateral+posterior malleolar fracture Trimalleolar fracture
Incarcerated fragment 5 4 6 7 22
Intrarticular loose body 4 1 0 12 17
Chaput-Wagstaffe fragment 6 4 0 13 23
Additional fracture line 17 9 0 0 26

Values are presented as number of cases.

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