title: Role of preoperative computed tomography scans in operative planning for malleolar ankle fractures.
abstract: BACKGROUND
  There remains no consensus regarding the role of computed tomography (CT) scans in preoperative planning for malleolar ankle fractures. The aim of this study was to determine the role of preoperative CT scans on operative planning in these fractures.
  
  
  METHODS
  A retrospective analysis was performed on 100 consecutive patients treated at our institution for malleolar ankle fractures (AO type 44) with both preoperative radiographs and CT scans. Six study participants reviewed available radiographs and formulated an operative (or nonoperative) plan including positioning, operative approach, and fixation. Participants then analyzed CT scans of the same fractures, deciding whether (and how) they would alter operative strategy. Characteristics of fractures and radiographs were correlated with changes in operative strategy.
  
  
  RESULTS
  Operative strategy was notably changed in 24% of cases after CT review, with strong intraclass correlation (0.733). Common changes included alterations in medial malleolar (21%) or posterior malleolar (15%) fixation and fixation of an occult anterolateral plafond fracture (9%). Notable predictors of changes in operative strategy included trimalleolar over unimalleolar fractures (29% vs 10% rate of change), preoperative dislocation over no dislocation (31% vs 20%), the presence of only radiographs with overlying plaster versus fractures with at least 1 set of radiographs without plaster (25% vs 14%), and suprasyndesmotic versus trans- and infra-syndesmotic fractures (40% vs 20% and 4%, respectively).
  
  
  CONCLUSIONS
  CT scans may be useful adjuncts in preoperative planning for malleolar ankle fractures, most notably in fracture dislocations, cases in which all available radiographs are obscured by plaster, trimalleolar fractures, and suprasyndesmotic fractures.
  
  
  METHODS
  Level III, retrospective comparative study.
authors: Massachusetts General Hospital, Boston, MA 02114, USA.
authors: Eric M
authors: EM
authors: Black
authors: Valentin
authors: V
authors: Antoci
authors: Jared T
authors: JT
authors: Lee
authors: Michael J
authors: MJ
authors: Weaver
authors: A Holly
authors: AH
authors: Johnson
authors: Seenu M
authors: SM
authors: Susarla
authors: John Y
authors: JY
authors: Kwon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D016268:Internal Fixators; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: CT scan; advanced imaging; malleolar ankle fracture; operative planning; trauma