Are orthopedic surgeons able to detect 3 mm and 5 mm joint step off on fluoroscopy?

The aim of this study was to examine whether joint step-off created experimentally at 3 mm and 5 mm in the tibial lateral plateau can be accurately evaluated by orthopedic surgeons on fluoroscopic images.

A lateral tibia plateau fracture was created experimentally on above-the-knee amputated material. Using a ruler, step-off at 3 mm and then at 5 mm was made on the joint surface, then joint and lateral fluoroscopy images were obtained. These images were evaluated by 316 orthopedic surgeons. The surgeons were asked whether the joint congruence in the plateau fracture required surgical correction. The same question was asked again after 3 months, and all the responses were recorded.

In the first measurements for 3 mm joint step-off, 77 (24.4%) orthopedic surgeons stated that surgical correction was necessary, and for 5 mm, 118 (37.3%) surgeons stated that surgical correction was necessary. In the 3rd month, the need for surgical correction was stated by 144 (45.6%) surgeons for 3 mm, and by 176 (55.7%) surgeons for 5 mm (p=0.001) CONCLUSIONS: Fluoroscopy is not a reliable method to determine articular step-off. Methods such as arthroscopic or open joint surface evaluation should be applied in the operating room.