[New possibilities in fracture visualization by means of CT: reconstructions, 3D plannings--difficult joint fractures--modern management--improved visualization and operative planning in joint fractures]

After having been introduced in the seventies computed tomography (CT) has become an important instrument for the diagnosis of difficult joint fractures. With the evolution of the Spiral-CT with multiplanar reformations and three-dimensional (3D-) reconstructions the quality of visualization has been improved considerably. In comparison with conventional radiography the actual CT scanners give a clear image of the fracture configuration and the degree of fragment displacement in joint fractures. Additional information about sub-/luxations of the joint, impaction and comminution is also clearly visualized by the CT. This means a rise in quality of fracture classification and enables a detailed view of the fracture pattern. These findings provide the basis for gratifying treatment regimens and surgical management of the injured joint. By the use of innovative reconstruction methods the CT allows exact visualization of internal fixations/osteosynthesis and secondary angular/rotation or length deformities postoperatively. Furthermore, reconstructed 3D-views enable preoperative computer simulated plannings of internal fixations and of reduction control intraoperatively. In fact, the actual Spiral-CT scanners are nearly equivalent in costs and total radiation dose compared to the performance of special projections of conventional radiographs. Thus, we recommend to enlarge the performance of additional CT diagnostic in difficult joint fractures and special pre- or postoperative cases.