Guesstimation of posterior malleolar fractures on lateral plain radiographs

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• 作者：D.T. Meijer^a ; ^{dtmeijer@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; J.N. Doornberg^a ; I.N. Sierevelt^b ; W.H. Mallee^a ; C.N. van Dijk^a ; G.M. Kerkhoffs^a ; S.A. Stufkens^a ; Ankle Platform Study Collaborative &ndash ; Science of Variation GroupEzequiel Palmanovich ; Maayke van Sterkenburg ; Andreas Engvall ; Ernesto Arroyo ; Maksym Golovakha ; Ernesto Pereira ; Eugene Toh Josep Torrent ; Daniel Haverkamp ; Ivan Bojanic ; Manuel Sousa ; Oscar Castro Aragon ; Alessandro Russo ; Carlos Cortes ; Gergely Pá ; nics ; Joã ; o Vide ; Loannis Spanos ; Manuel Santos Carvalho ; Pablo Maggi ; Zach Thomas ; Hirofumi Tanaka ; Mauro Dinato ; Jakob Fay ; Vytautas Kimtys ; Antó ; nio José ; Correia Moreira ; Dimitrios Hatziemmanuil ; Tze-Choong Low ; Laurens Wessel van der Plaat ; Allan David Mora ; Inge van Rensen ; Javier del Vecchio ; James Ramos ; Jorge Azevedo ; Carlos Bustamante ; Alexandre Oliveira ; Htwe Zaw ; Harish Kurup ; Tero Yli-Kyyny ; Emre Baca ; Heidi Haapasalo ; Gurgen Bakhtamyan ; Piotr Zbikowski ; Juan Kalb ; Peter Hemmingsson ; Miguel Pinheiro ; James Davenport ; Pier Luigi Guidi ; Ana Paula Simoes da Silva ; Goncalo Martinho ; Pietro Spennacchio ; Yury Postnov ; Niv Dreiangel ; Nelson Gomes Junior ; Igor Frangez ; Iain Bissell ; Yasir Khan ; Alar Toom ; Christiaan van Bergen ; Henryk Liszka ; Nestor Moreno ; Balá ; zs Patczai ; Max van den Bogaert ; Christopher Marquis ; Amro Kamal Hussein ; Mette Andersen ; Lozefina Botezatu ; Francisco Flores Santos ; Caio Nery ; Semin Becirbegovc ; Cristhopher Lucca Stoffel ; Paulo Ferrao ; Ivan Rakovac ; Nikica Darabos ; Paolo Sicchiero ; Kostava Tengiz ; Luciano Keiserman ; Ewe Juan Yeap ; Andrè ; Luiz Rocha de Souza ; Samir Abdulsalam ; Acacio Ramos ; Nicolú ; Martinelli ; Stefaan Verfaillie ; Carmen Silva ; Sjoerd Stufkens ; Vasileios Chouliaras ; Daniel da Costa ; Richard Freihaut ; Gythe Bulstra ; Alon Burg ; Ben Rudge ; Ali Abdelwahab ; Adrian Sirio ; Troy Watson ; Ana Rita Gaspar ; Ian Sharp ; Munier Hossain ; Derek van Deurzen ; Michel van den Bekerom ; Jan-Joost Wiegerinck ; Inge van Eekeren ; Robert-Jan de Muinck Keizer
• 关键词：Posterior malleolar fragment ; X-ray ; Q3DCT ; Ankle ; Trauma
• 刊名：Injury
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：46
• 期：10
• 页码：2024-2029
• 全文大小：1081 K

文摘

Accurate assessment of articular involvement of the posterior malleolar fracture fragments in ankle fractures is essential, as this is the leading argument for internal fixation. The purpose of this study is to assess diagnostic accuracy of measurements on plain lateral radiographs.

Methods

Quantification of three-dimensional computed tomography (Q-3D-CT) was used as a reference standard for true articular involvement (mm²) of posterior malleolar fractures. One-hundred Orthopaedic Trauma surgeons were willing to review 31 trimalleolar ankle fractures to estimate size of posterior malleolus and answer: (1) what is the involved articular surface of the posterior malleolar fracture as a percentage of the tibial plafond? and (2) would you fix the posterior malleolus?

Results

The average posterior malleolar fragment involved 13.5% (SD 10.8) of the tibial plafond articular surface, as quantified using Q-3D-CT. The average involvement of articular surface of the posterior malleolar fragment, as estimated by 100 observers on plain radiographs was 24.4% (SD 10.0). The factor 1.8 overestimation of articular involvement was statistically significant (m>pm> < 0.001). Diagnostic accuracy of measurements on plain lateral radiographs was 22%. Interobserver agreement (ICC) was 0.61. Agreement on operative fixation, showed an ICC of 0.54 (Haraguchi type I = 0.76, Haraguchi type II = 0.40, Haraguchi type III = 0.25).

Conclusions

Diagnostic accuracy of measurements on plain lateral radiographs to assess articular involvement of posterior malleolar fractures is poor. There is a tendency to misjudge posteromedial involvement (Haraguchi type II).