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Guesstimation of posterior malleolar fractures on lateral plain radiographs

2015; Elsevier BV; Volume: 46; Issue: 10 Linguagem: Inglês

10.1016/j.injury.2015.07.019

1879-0267

Diederik T. Meijer, Job N. Doornberg, Inger N. Sierevelt, Wouter H. Mallee, C. N. van Dijk, Gino M. M. J. Kerkhoffs, Sjoerd A. S. Stufkens, Ezequiel Palmanovich, Maayke van Sterkenburg, Andreas Engvall, Ernesto Arroyo, М. Л. Головаха, Ernesto Pereira, Josep Torrent, Daniël Haverkamp, Ivan Bojanić, Manuel Sousa, Oscar Castro Aragon, Alessandro Russo, Carlos Cortés, Gergely Pánics, João Vide, Loannis Spanos, Manuel Santos Carvalho, Pablo Maggi, Zach Thomas, Hirofumi Tanaka, Mauro César Mattos e Dinato, Jakob Fay, Vytautas Kimtys, António José Correia Moreira, Dimitrios Hatziemmanuil, Tze-Choong Low, Laurens Wessel van der Plaat, Allan David Mora, Inge van Rensen, Jorge Javier Del Vecchio, James Ramos, Jorge Manuel Teixeira de Azevedo, Carlos Ariel Bustamante, Alexandre Cassini de Oliveira, Htwe Zaw, Harish Kurup, Tero Yli-Kyyny, Emre Baca, Heidi Haapasalo, Gurgen Bakhtamyan, Piotr Żbikowski, J C Kalb, Peter Hemmingsson, Miguel Pinheiro, James Davenport, Pier Luigi Guidi, Ana Paula Simoes da Silva, Gonçalo Martinho, Pietro Spennacchio, Yury Postnov, Niv Dreiangel, Nelson Pinto Gomes, Igor Frangež, Iain Bissell, Yasir Khan, Alar Toom, Christiaan J. A. van Bergen, Henryk Liszka, N. Moreno, Balázs Patczai, Max van den Bogaert, Christopher Marquis, Amro Kamal Hussein, Mette Renate Andersen, Lozefina Botezatu, Francisco Flores Santos, Caio Nery, Semin Becirbegovc, Cristhopher Stoffel, Paulo N. F. Ferrao, Ivan Rakovac, Nikica Daraboš, Paolo Sicchiero, Kostava Tengiz, Luciano Keiserman, Ewe Juan Yeap, André Luís Rocha de Souza, Samir Abdulsalam, Ramos Acacio, Nicolò Martinelli, Stefaan Verfaillie, Cármen Silva, Sjoerd A. S. Stufkens, Vasileios Chouliaras, Daniel Costa, Richard Freihaut, Gythe H. Bulstra, Alon Burg, Ben Rudge, Ali Abdelwahab, Adrián Sirio, Troy S. Watson, Ana Rita Gaspar, Ian Sharp, Munier Hossain, Derek F.P. van Deurzen, Michel van den Bekerom, Jan-Joost Wiegerinck, Inge Van Eekeren, Robert-Jan de Muinck Keizer,

Orthopedic Surgery and Rehabilitation

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.Quantification of three-dimensional computed tomography (Q-3D-CT) was used as a reference standard for true articular involvement (mm(2)) 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?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 (p<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).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).