title: Vascular abnormalities as assessed with CT angiography in high-energy tibial plafond fractures.
abstract: OBJECTIVE
  The purpose of this study was to examine the results of computed tomography angiography (CTA) obtained in patients with high-energy tibial plafond fractures and assess if the information gleaned from CTA could be useful to the treating orthopedic surgeon.
  
  
  METHODS
  Consecutive patient series.
  
  
  METHODS
  Level 2 trauma center.
  
  
  METHODS
  Consecutive patients treated between October 1, 2004 and June 31, 2006 for high-energy injury of the tibial plafond according to a protocol of early temporizing external fixation, CT, and elevation, followed by delayed reconstruction of the tibial plafond.
  
  
  METHODS
  Addition of angiography to CT scan (CTA) in treatment protocol.
  
  
  METHODS
  CTA abnormalities were identified and categorized to define the pattern of arterial lesions present. Characteristics of patients, injuries, treatments, and complications were evaluated and related to CTA findings.
  
  
  RESULTS
  CTA was performed at an average of 3 days postinjury in 25 consecutive patients treated for high-energy tibial plafond fractures. Abnormalities of the arterial tree of the leg were seen in 13 of 25 (52%) patients. One patient had 2 of 3 vessels notably injured. Fourteen arteries showed acute changes at the level of injury and 1 showed significant chronic atherosclerotic disease at the trifurcation. Acute arterial abnormalities included 7 arteries with complete occlusion, 2 with partial occlusion/diminished flow, and 5 with normal flow but with anatomic disturbances (4 tenting over and 1 entrapped by fracture fragments). Open fractures were associated with arterial abnormalities (P<0.05), but no other characteristics correlated with arterial injury. No patients had dye reactions or other problems relating to CTA. Patients with CTA-diagnosed vascular abnormalities were treated with more minimally invasive surgery than those without at the discretion of the surgeon, and no patients with vascular abnormalities had wound problems or infection.
  
  
  CONCLUSIONS
  In more than half of high-energy tibial plafond fractures, CTA identified significant abnormalities to the arterial tree of the distal leg. These injuries most commonly involved the anterior tibial artery and included a variety of lesions. CTA appears to be a safe and potentially useful tool for the assessment and preoperative planning of high-energy tibial plafond fractures.
authors.affiliation: University of Texas, Southwestern, Dallas, Texas, USA.
authors.forename: George F
authors.initials: GF
authors.lastname: LeBus
authors.forename: Cory
authors.initials: C
authors.lastname: Collinge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D016267:External Fixators; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012421:Rupture / Q000000981:diagnostic imaging; D016909:Tibial Arteries / Q000000981:diagnostic imaging* / Q000293:injuries*; D013978:Tibial Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery