TY - JOUR
T1 - Diagnostic Accuracy of 2-Dimensional Computed Tomography for Articular Involvement and Fracture Pattern of Posterior Malleolar Fractures
AU - Ankle Platform Study Collaborative – Science of Variation Group
AU - Meijer, Diederik T
AU - de Muinck Keizer, Robert-Jan O
AU - Doornberg, Job N
AU - Sierevelt, Inger N
AU - Stufkens, Sjoerd A
AU - Kerkhoffs, Gino M M J
AU - van Dijk, C Niek
AU - AUTHOR GROUP
AU - Engvall, Adnreas
AU - Golovakha, Maksym
AU - Pereira, Ernesto
AU - Torrent, Josep
AU - Haverkamp, Daniel
AU - Bojanic, Ivan
AU - Sousa, Manuel
AU - Aragon, Oscar Castro
AU - Russo, Alessandro
AU - Cortes, Carolos
AU - Pánics, Gergely
AU - Vide, João
AU - Santos Carvalho, Manuel
AU - Thomas, Zach
AU - Tanaka, Hirofumi
AU - Dinato, Mauro
AU - Correia Moreira, José
AU - Hatziemmanuil, Dimitrios
AU - van der Plaat, Laurens Wessel
AU - del Vecchio, Javier
AU - Zaw, Htwe
AU - Kurup, Harish
AU - Baca, Emre
AU - Zbikowski, Piotr
AU - Hemmingsson, Peter
AU - Pinheiro, Miguel
AU - Davenport, James
AU - Spennacchio, Pietro
AU - Dreiangel, Niv
AU - Bissell, Iain
AU - Toom, Alar
AU - van den Bogaert, Max
AU - Marquis, Christopher
AU - Andersen, Mette
AU - Ferrao, Paulo
AU - Darabos, Nikica
AU - Siocchiero, Paolo
AU - Keiserman, Luciano
AU - Yeap, Ewe Juan
AU - Roche de Souza, André Luiz
AU - Abdulsalam, Samir
AU - Martinelli, Nicolú
AU - van den Bekerom, Michel
N1 - © The Author(s) 2015.
PY - 2016/1
Y1 - 2016/1
N2 - BACKGROUND: Up to 44% of ankle fractures have involvement of the posterior tibial margin. Fracture size and morphology are important factors to guide treatment of these fragments, but reliability of plain radiography in estimating size is low. The aim of the current study was to evaluate the accuracy of 2-dimensional computed tomography (2DCT) in the assessment of posterior malleolar fractures. Additionally, the diagnostic accuracy of 2DCT and its value in preoperative planning was evaluated.METHODS: Thirty-one patients with 31 ankle fractures including a posterior malleolar fragment were selected. Preoperative CT scans were analyzed by 50 observers from 23 countries. Quantitative 3-dimensional CT (Q3DCT) reconstructions were used as a reference standard.RESULTS: Articular involvement of the posterior fragment was overestimated on 2DCT by factors 1.6, 1.4, and 2.2 for Haraguchi types I, II, and III, respectively. Interobserver agreement on operative management ("to fix, or not to fix?") was substantial (κ = 0.69) for Haraguchi type I fractures, fair (κ = 0.23) for type II fractures, and poor (κ = 0.09) for type III fractures. 2DCT images led to a change in treatment of the posterior malleolus in 23% of all fractures. Surgeons would operatively treat type I fractures in 63%, type II fractures in 67%, and type III fractures in 22%.CONCLUSION: Surgeons overestimated true articular involvement of posterior malleolar fractures on 2DCT scans. 2DCT showed some additional value in estimating the involved articular surface when compared to plain radiographs; however, this seemed not yet sufficient to accurately read the fractures. Analysis of the CT images showed a significant influence on choice of treatment in 23% with a shift toward operative treatment in 12% of cases compared to evaluating plain lateral radiographs alone.LEVEL OF EVIDENCE: Level III, comparative study.
AB - BACKGROUND: Up to 44% of ankle fractures have involvement of the posterior tibial margin. Fracture size and morphology are important factors to guide treatment of these fragments, but reliability of plain radiography in estimating size is low. The aim of the current study was to evaluate the accuracy of 2-dimensional computed tomography (2DCT) in the assessment of posterior malleolar fractures. Additionally, the diagnostic accuracy of 2DCT and its value in preoperative planning was evaluated.METHODS: Thirty-one patients with 31 ankle fractures including a posterior malleolar fragment were selected. Preoperative CT scans were analyzed by 50 observers from 23 countries. Quantitative 3-dimensional CT (Q3DCT) reconstructions were used as a reference standard.RESULTS: Articular involvement of the posterior fragment was overestimated on 2DCT by factors 1.6, 1.4, and 2.2 for Haraguchi types I, II, and III, respectively. Interobserver agreement on operative management ("to fix, or not to fix?") was substantial (κ = 0.69) for Haraguchi type I fractures, fair (κ = 0.23) for type II fractures, and poor (κ = 0.09) for type III fractures. 2DCT images led to a change in treatment of the posterior malleolus in 23% of all fractures. Surgeons would operatively treat type I fractures in 63%, type II fractures in 67%, and type III fractures in 22%.CONCLUSION: Surgeons overestimated true articular involvement of posterior malleolar fractures on 2DCT scans. 2DCT showed some additional value in estimating the involved articular surface when compared to plain radiographs; however, this seemed not yet sufficient to accurately read the fractures. Analysis of the CT images showed a significant influence on choice of treatment in 23% with a shift toward operative treatment in 12% of cases compared to evaluating plain lateral radiographs alone.LEVEL OF EVIDENCE: Level III, comparative study.
KW - Ankle Fractures/classification
KW - Female
KW - Humans
KW - Imaging, Three-Dimensional
KW - Male
KW - Observer Variation
KW - Preoperative Care
KW - Reproducibility of Results
KW - Sensitivity and Specificity
KW - Tomography, X-Ray Computed
U2 - 10.1177/1071100715603999
DO - 10.1177/1071100715603999
M3 - Article
C2 - 26420736
SN - 1071-1007
VL - 37
SP - 75
EP - 82
JO - Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society
JF - Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society
IS - 1
ER -