title: Standard perioperative imaging modalities are unreliable in assessing articular congruity of ankle fractures.
abstract: OBJECTIVE
  To determine the sensitivity, specificity, and interobserver and intraobserver reliabilities of intraoperative fluoroscopy and postoperative plain radiographs (XR) in the assessment of articular congruency after open reduction and internal fixation (ORIF) of ankle fractures involving the tibial plafond.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Academic level 1 trauma center.
  
  
  METHODS
  One hundred five patients treated surgically for rotational ankle fractures.
  
  
  METHODS
  ORIF.
  
  
  METHODS
  Sensitivity, specificity, and interobserver and intraobserver reliabilities of fluoroscopy and plain radiographs when compared with computed tomography imaging.
  
  
  RESULTS
  The sensitivities of fluoroscopy and XR were 21% and 36%, respectively. Specificities were 95% (fluoroscopy) and 89% (XR). Fluoroscopy interobserver reliability was κ = 0.15, and mean intraobserver reliability was κ = 0.32. XR interobserver and mean intraobserver reliabilities were κ = 0.30 and κ = 0.59.
  
  
  CONCLUSIONS
  Although results show acceptable specificity, the reliability and sensitivity of both intraoperative fluoroscopy and postoperative XR in the assessment of ankle articular congruency are low. This calls into question available literature correlating clinical results with articular reduction. During ORIF of an intra-articular ankle fracture, surgeons should be highly critical of fluoroscopic imaging that seems adequately reduced and direct visualization of the articular surface should be used as a reduction aid if possible. Furthermore, in the postoperative period, axial imaging may be warranted in patients who have poor clinical outcomes despite apparent anatomic articular reduction to evaluate for occult joint incongruence.
authors.affiliation: *Hospital for Special Surgery, New York, NY; and †Department of Orthopaedics, Weill Cornell Medical College, New York, NY.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Garner
authors.forename: Peter D
authors.initials: PD
authors.lastname: Fabricant
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Schottel
authors.forename: Marschall B
authors.initials: MB
authors.lastname: Berkes
authors.forename: Andre D
authors.initials: AD
authors.lastname: Shaffer
authors.forename: Amelia
authors.initials: A
authors.lastname: Ni
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015588:Observer Variation; D019990:Perioperative Care / Q000379:methods; D011859:Radiography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult