Usefulness of Computed Tomography in Patients with Acute Malleolar Fracture

The authors describe a case involving an isolated posterior fibular malleolar fracture in an 80-year-old female, which was identified on multiple lateral radiographs of the involved ankle and confirmed by computed tomography. The patient was treated conservatively with 10 weeks of walking cast immobilization, resulting in poorly acceptable radiographic and clinical results. The authors review the anatomy of the area of involvement. A literature review, the clinical case study, and a discussion of the difficulty in evaluation of these types of fibular fractures are presented along with a protocol for the diagnosis and treatment of these fractures.

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The Lateral Trans-Malleolar approach for Posterior Malleolar Fracture of the Ankle: A Clinical and Computed Tomography Evaluation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00463 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0046

Author(s):

Masanori Taki ◽

Naohiro Hio

Keyword(s):

Computed Tomography ◽

External Rotation ◽

Articular Surface ◽

Clinical Results ◽

Direct Visualization ◽

Malleolar Fracture ◽

Aofas Score ◽

Posterior Malleolar Fracture ◽

Posterior Malleolus

Category: Ankle; Trauma Introduction/Purpose: Posterior malleolar fracture reduction including the articular surface of trimalleolar ankle fracture has been reported to be an important prognostic factor. The lateral trans-malleolar approach (LTA) is a surgical approach that provides direct visualization of the articular surface of the posterior malleolus. We herein report the clinical results and computed tomography (CT) findings for the articular reduction status after LTA for posterior malleolar fracture of the ankle. Methods: Sixteen patients (9 men, 7 women, mean age 52.6+-18.1 years old) who underwent the LTA for posterior malleolar fracture of the ankle and were followed for at least 1 year were evaluated retrospectively. The types of ankle malleolar fracture according to the Lauge-Hansen classification were Supination-External rotation (SER) in 13 patients and Pronation-External rotation (PER) in 3 patients. The CT classifications of posterior malleolus fracture by Haraguchi were Type 1 in 6 cases, Type 2 in 10 cases and Type 3 in 0 cases. The AOFAS score, post-surgical complications and reduction status of the posterior malleolus on CT were investigated. Results: The mean follow-up period was 15.5 months. The AOFAS score was 93.0+-5.2 points. Postoperative complications were seen in one case of superficial infection; however, delayed union, nonunion and fibular necrosis were not observed. The articular step-off in CT improved significantly after surgery (5.9+-2.9 mm preoperatively vs. 0.6+-0.8 mm postoperatively). The 2 patients who showed an articular step-off exceeding 1 mm were both Haraguchi type 2 posterior malleolar fracture. Conclusion: Several approaches for managing posterior malleolus of the ankle have been reported. However, few provide direct visualization to the articular surface. The LTA requires relatively substantial invasion, but it can facilitate surgery in the supine position and thereby reduce the articular surface directly. In our experience, the LTA provided favorable clinical results and fracture reductions. Even when utilizing the LTA, it remains difficult to confirm the fracture reduction of medial articular surface for Haraguchi type 2 medial extension fractures. Therefore, it remains important to also perform appropriate intraoperative X-ray controls.

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PO 18112 - Computed tomography modifies the diagnosis of ankle fractures

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.991 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 14S

Author(s):

Caroline Marques Dos Santos Cavaleiro Cruel Neves ◽

Nacime Salomão Barbachan Mansur ◽

Vinicius Felipe Pereira ◽

Fausto Santana Celestino ◽

Diego Costa Astur ◽

...

Keyword(s):

Computed Tomography ◽

Clinical Practice ◽

Random Order ◽

Medical Specialty ◽

Ankle Fractures ◽

High Rate ◽

Years Of Experience ◽

Foot And Ankle ◽

Malleolar Fracture ◽

Articular Fractures

Introduction: Ankle fracture is an injury with a high rate of surgical indication in clinical practice. Treatment decisions are classically based on radiographs (XR) of the region; however, this approach may be imprudent considering the frequent difficulty of reading them. In recent years, some researchers have advocated the use of computed tomography (CT) as an auxiliary instrument in the diagnosis and surgical planning of treatment for this injury. Our study aims to demonstrate the superiority of the combination of CT with XR for evaluating ankle fractures. Methods: Examinations (XR and CT) of 53 patients with ankle fractures seen from 2011 to 2016 were collected. Seven raters (2 foot and ankle experts, 1 foot and ankle surgeon with less than 5 years of experience in the medical specialty, 2 foot and ankle surgeons with more than 5 years of experience in the medical specialty and 2 general orthopedists with more than 5 years of board certification) evaluated the unlabeled examinations in random order and identified the injuries found on XR alone and those also detected on CT. The data were subjected to statistical analysis. Results: The characteristics of medial malleolar fracture (posteromedial and anterior colliculus fragment), the presence of posterior malleolar fracture and its characteristics (avulsion, deviation, fragment larger than 25%, posteromedial and posterolateral fragment) and syndesmosis injury and the absence of deltoid bone injury were clearer in CT combined with XR than in exclusively radiographic examinations in all groups, with high intraobserver reliability. Conclusion: Our study shows that conventional XR at 3 positions may fail to reveal more subtle injuries. CT emerges in this scenario as an extremely widespread and well-supported examination in the approach to articular fractures, although it is not yet fully incorporated into clinical practice for ankle fractures. Our conclusion is that this examination increases diagnostic accuracy and may improve the quality of information available to the clinician and surgeon, who thus gain access to more data, which may positively influence patient care.

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CT Analysis of the Posteromedial Fragment of the Posterior Malleolar Fracture

Foot & Ankle International ◽

10.1177/1071100719830999 ◽

2019 ◽

Vol 40 (6) ◽

pp. 648-655 ◽

Cited By ~ 8

Author(s):

Amir Reza Vosoughi ◽

Malwattage Lara Tania Jayatilaka ◽

Benjamin Fischer ◽

Andrew P. Molloy ◽

Lyndon W. Mason

Keyword(s):

Computed Tomography ◽

Surgical Planning ◽

Injury Pattern ◽

Computed Tomography Scan ◽

Malleolar Fracture ◽

Level Of Evidence ◽

Posterior Malleolar Fracture ◽

Posterior Malleolus ◽

Ct Analysis ◽

Tomography Scan

Background: To date, there have been no studies describing the characteristics of posteromedial fragment in the posterior malleolus fracture. The aim was to investigate the variability of posteromedial fracture fragments to enable better surgical planning. Methods: All Mason and Molloy type 2B fractures, defined as fracture of both the posterolateral and the posteromedial fragments of the posterior malleolus, from our database were identified to analyze the preoperative computed tomography scan. The posteromedial fragment was investigated in 47 cases (mean age, 46.6 years; 11 male, 36 female). Results: Morphologically, the fracture could be divided into 2 subtypes: (1) a large pilon intra-articular fragment (mean of X axis: 33.0 mm, Y: 30.7 mm, Z: 31.7 mm) presented in 29 cases with mean interfragmentary angle of 32.1 and back of tibia angle of 32.7 degrees (this was seen in 25 of 27 cases with supination injury pattern); and (2) a small extra-articular avulsion fragment (mean of X axis: 9.6 mm, Y: 13.2 mm, Z: 11.5 mm) present in 18 cases with a mean interfragmentary angle of 11.0 and back of tibia angle of 10.1 degrees. It was seen in 80% of pronation injuries. Conclusion: The avulsion type of the posteromedial fragment of posterior malleolus fracture was more common in pronation injuries, likely the result of traction by the intermalleolar ligament, and the pilon type was more common in supination injuries, likely the result of the rotating talus impaction. Because of the intra-articular involvement, we believe the pilon type should undergo fixation to achieve articular congruity, unlike the avulsion type which may only function as a secondary syndesmotic stabilizer. Level of Evidence: Level III, retrospective comparative series.

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X-ray microtomography

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100107058 ◽

1988 ◽

Vol 46 ◽

pp. 998-999

Author(s):

H.W. Deckman ◽

B.F. Flannery ◽

J.H. Dunsmuir ◽

K.D' Amico

Keyword(s):

Computed Tomography ◽

Internal Structure ◽

Imaging Technique ◽

Three Dimensional ◽

Tissue Structure ◽

Individual Element ◽

X Ray ◽

Non Invasive ◽

Panoramic Imaging ◽

Three Dimensional Images

We have developed a new X-ray microscope which produces complete three dimensional images of samples. The microscope operates by performing X-ray tomography with unprecedented resolution. Tomography is a non-invasive imaging technique that creates maps of the internal structure of samples from measurement of the attenuation of penetrating radiation. As conventionally practiced in medical Computed Tomography (CT), radiologists produce maps of bone and tissue structure in several planar sections that reveal features with 1mm resolution and 1% contrast. Microtomography extends the capability of CT in several ways. First, the resolution which approaches one micron, is one thousand times higher than that of the medical CT. Second, our approach acquires and analyses the data in a panoramic imaging format that directly produces three-dimensional maps in a series of contiguous stacked planes. Typical maps available today consist of three hundred planar sections each containing 512x512 pixels. Finally, and perhaps of most import scientifically, microtomography using a synchrotron X-ray source, allows us to generate maps of individual element.

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