title: The role of CT in diagnosis and treatment of distal tibial fractures with intra-articular involvement in children.
abstract: OBJECTIVE
  Distal tibial fractures with intra-articular involvement during childhood are injuries with potentially severe complications if not treated promptly. Daily clinical practice indicates that sole use of plain radiographs may lead to misdiagnosis and subsequent erroneous selection of suitable treatment. The role of computed tomography (CT) in the classification and treatment decision of these injuries is unclear. This study aims to determine whether CT evaluation is required in the management of these fractures.
  
  
  METHODS
  We assessed 64 distal tibial fractures with intra-articular involvement on two separate occasions in a blinded study, in order to classify the fracture and decide the appropriate treatment approach. In the first part of the study, plain radiographs were evaluated in order to diagnose the type of the fracture and select the appropriate treatment. In the second part, CT scans were performed in the same patients in order to re-evaluate diagnosis and treatment. The study included fractures prior to physeal closure (Salter-Harris III and IV fractures, n=32) as well as transitional fractures (J. Tillaux and triplane fractures, n=32).
  
  
  RESULTS
  According to plain radiographs, 31 patients were diagnosed with SH III fracture, 8 with SH IV, 9 with J. Tillaux and 16 with triplane fracture. Surgical treatment was decided in 18 patients and non-surgical in 46. After CT scan evaluation, 20 patients were diagnosed with SH III, 12 with SH IV, 9 with J. Tillaux, and 23 with triplane fracture. In this occasion the number of patients referred for surgical treatment raised to 42 leaving only 22 patients to be treated conservatively.
  
  
  CONCLUSIONS
  Computed tomography lead to changes in fracture classification and treatment decision. Treatment decision changed for 24 patients after CT evaluation. Treatment decision in patients with SH III and IV did not change significantly opposed to patients with transitional fractures, where CT scan had major impact on treatment decision. Despite the irradiation of immature skeleton and higher cost containment, this study indicates that patients with transitional distal tibial fractures as well as patients with displaced SH III and IV fractures must undergo CT examination in order to make accurate diagnosis and select the appropriate treatment.
authors.affiliation: 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: aleknen@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Nenopoulos
authors.affiliation: 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: T
authors.initials: T
authors.lastname: Beslikas
authors.affiliation: 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Gigis
authors.affiliation: 3rd Orthopaedic Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: F
authors.initials: F
authors.lastname: Sayegh
authors.affiliation: 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Christoforidis
authors.affiliation: 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Hatzokos
mesh_terms: D000293:Adolescent; D002648:Child; D003657:Decision Making; D004311:Double-Blind Method; D005260:Female; D006115:Greece; D006801:Humans; D057072:Intra-Articular Fractures / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D011300:Preoperative Care; D015203:Reproducibility of Results; D013978:Tibial Fractures / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices
keywords: Computed tomography; Distal tibial fractures; Intra-articular involvement; Transitional fractures of distal tibia; Treatment decision