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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
Lateral ankle radiographs: do we really understand what we are seeing?
Matt L Graves1, John Kosko, David P Barei
1Division of Trauma; Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS, USA. Mattgraves1@gmail.com
Journal of Orthopaedic Trauma
|January 20, 2011
Summary
Lateral fluoroscopic imaging is unreliable for assessing tibial plafond reduction, especially for small osteochondral fragments. Direct visualization is crucial for confirming anatomic reduction in ankle fracture surgery.
Area of Science:
- Orthopedic Surgery
- Radiology
- Biomechanical Engineering
Background:
- Assessing the reduction of tibial plafond articular surfaces is critical in treating pilon fractures.
- Lateral intraoperative fluoroscopy is commonly used but its accuracy is debated.
Purpose of the Study:
- To evaluate the validity of lateral intraoperative fluoroscopic imaging for assessing tibial plafond reduction.
- To determine if the distal tibial subchondral shadow is equally represented by all tibial portions.
- To assess the detectability of 5-mm osteochondral fragment displacement on lateral fluoroscopy.
Main Methods:
- Cadaveric tibial plafond specimens were sectioned and imaged laterally after sequential fragment removal.
- Simulated 5-mm osteochondral fragment displacements were created and imaged.
- Experienced ankle surgeons assessed images for displacement, and inter/intraobserver reliability was calculated.
Main Results:
- The subchondral shadow on lateral radiographs is formed equally by medial, central, and lateral tibial aspects.
- Surgeons identified malreductions in only 45% of cases.
- Interobserver reliability (0.183) and intraobserver reliability (0.474) were very poor.
Conclusions:
- Lateral fluoroscopy is insufficient for detecting displacement of small osteochondral fragments.
- Anatomic reduction of the tibial plafond cannot be confidently confirmed with lateral fluoroscopy alone.
- Direct visualization of the articular surface is essential for accurate assessment of reduction.
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