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· DOS Abstracts
Influence of computer tomography scans on
treatment of bi- and trimalleolar fractures
Mads Terndrup, Amandus Gustafsson, Kolja Weber, Kristoffer Barfod, Anders
Troelsen, Ilija Ban
Ortopædkirurgisk afdeling, Hvidovre Hospital; Ortopædkirurgisk afdeling,
Rigshospitalet; Ortopædkirurgisk afdeling, Rigshospitalet; Ortopædkirurgisk
afdeling, Køge hospital; Ortopædkirurgisk afdeling, Hvidovre hospital;
Ortopædkirurgisk afdeling, Hvidovre hospital
Background:
Several studies have indicated that plain radiographs are insuf-
ficient in evaluation of complex malleolar fractures. In one recent study this was
especially true for trimalleolar fractures, dislocated fractures, suprasyndesmotic
fractures and in cases where plaster obscured the fracture area. However these
studies have been either small or retrospective
Purpose / Aim of Study:
To assess change of planned operative management
(patient positioning, surgical approach and fixation) between preoperative x-
ray and CT-evaluation
Materials and Methods:
Adult patients with bi- or trimalleolar fractures or
unimalleolar fractures with dislocation were CT-scanned. The surgeon subse-
quently filled out a purpose made form after 1) evaluation of x-rays, 2) evalua-
tion of CT-scans and 3) performed surgery. The form addressed among others
AO classification, location of fracture step-off, patient positioning, planned inci-
sions and fixation of medial and lateral malleoli, posterior tibia and the syndes-
mosis. 69 patients were included
Findings / Results:
Change in AO-classification (p= .035) and presence of
fracture step-off in the posterior tibia (p= .003) was significant after x-ray and
CT-scan evaluation. Changes in planned incisions (17,4%) and patient position-
ing (8,7%) were more frequent after X-ray and CT- scan evaluation compared
to plan after CT and performed surgery, (1,4%) and (4,3%) respectively, but
these findings were non- significant. Changes in planned fixation after x- ray
and CT-scan evaluation (29,0%) was lower than the change seen between plan
after CT- scan and actually performed surgery (37,7%)
Conclusions:
The role of preoperative CT-scans in the management of ankle
fractures is unclear. Our results indicate a more precise AO classification and
detection of fracture step-off in the posterior tibia, but CT-scans do not seem
to change surgical management
No conflicts of interest reported
31.