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Computed Tomography's Impact on the Surgical Planning for Posterior Malleolar Fractures
Noé De Marchi Neto1, Pietro Felice Tomazini Nesello1, Jordanna Maria Pereira Bergamasco1
1Department of Orthopedics and Traumatology, Santa Casa de São Paulo - Pavilhão Fernandinho Simonsen, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil.
Objective:
This study aimed to evaluate the influence of computed tomography (CT) on the preoperative planning of posterior malleolus (PM) fractures of the ankle, comparing its information with that of conventional radiographs and assessing its impact on surgical treatment.
Methods:
The study included 81 patients with PM fractures, whose radiological and CT images were analyzed by 33 specialized orthopedic surgeons. The study had two stages, with a radiological assessment on the first, and the second having radiological plus CT evaluation. In both stages, we asked surgeons about the PM size, fracture stability, preoperative management, and potential modifications after CT analysis.
Results:
Considering only radiographs, 83.5% of the evaluators selected PM fixation. However, CT addition modified this choice in 49.1% of the cases, influencing the surgical access route and the type of osteosynthesis. In 34.7% of cases, CT revealed a larger PM fragment than radiographs, demonstrating that it is superior in evaluating fracture size and morphology.
Conclusion:
The surgical planning of ankle fractures with PM involvement should routinely include CT scans for a more precise fracture line assessment and a potential change in the therapeutic decision based on simple radiography alone.
