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Unilateral CT systematically overestimates syndesmotic malreduction: Clinical implications of bilateral CT assessment
Brecht Van Der Velden1, Jed Campbell2, Bhavin Jadav2
1Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia; Department of Orthopaedic Surgery, University Medical Center Groningen, the Netherlands.
Background:
Bilateral computed tomography (CT) accounts for patient-specific anatomical variation in postoperative syndesmotic assessment, but unilateral CT remains common.
Methods:
This retrospective single-center cohort study included 144 patients who underwent ankle fracture fixation with syndesmotic stabilization and postoperative bilateral low-dose CT. Paired unilateral and bilateral classifications based on validated CT criteria were compared using McNemar's test.
Results:
Classification differed in 21 of 144 cases (14.6%). Relative to bilateral assessment, unilateral CT overestimated malreduction in 17 cases (11.8%) and missed malreduction in 4 cases (2.8%). Interobserver agreement was substantial (κ = 0.795).
Conclusions:
Unilateral CT more often classified syndesmotic reduction as malreduced than bilateral CT. Bilateral low-dose CT may improve interpretation when revision surgery is being considered.
Levels Of Evidence:
Level III.
