title: Value of Early Postoperative Computed Tomography Assessment in Ankle Fractures Defining Joint Congruity and Criticizing the Need for Early Revision Surgery.
abstract: Previous investigators have questioned the reliability of plain radiographs in assessing the accuracy of ankle fracture reduction when these were compared with the computed tomography (CT) evaluation in the preoperative setting, in particular, in fractures with syndesmosis injuries or trimalleolar fragments. The role of CT assessment, however, has not been investigated in the early postoperative setting. In the early postoperative setting, reduction still relies most commonly on fluoroscopy and plain radiographs alone. In the present study, we hypothesized that early postoperative CT assessment of ankle fractures with syndesmosic injuries and posterior malleolar fragments can add valuable information about the joint congruity compared with plain radiographs alone and that this information could affect the decisions regarding the need for early revision surgery. A total of 352 consecutive operated ankle fractures were reviewed. Of these, 68 (19%) underwent early postoperative CT assessment and were studied further to identify the causes that prompted revision surgery. Of the 68 cases, despite acceptable reduction found on the plain radiographs, 20 (29%) underwent early (within 1 week) revision surgery after studying the CT scans, which revealed malreduction of the syndesmosis, malreduction of the posterior lip fragment, and intra-articular fragments. We concluded that in ankle fractures involving disruptions of the syndesmosis or posterior malleolar fragments, early postoperative CT assessment could be justified, because it will reveal malreduction and prompt early revision intervention for a substantial proportion of these patients.
authors.affiliation: Department of Orthopedics, Meir Medical Center, affiliated with Sacker School of Medicine, Tel Aviv University, Kfar Saba, Israel. Electronic address: ezepalm@gmail.com.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Palmanovich
authors.affiliation: Department of Orthopedics, Meir Medical Center, affiliated with Sacker School of Medicine, Tel Aviv University, Kfar Saba, Israel.
authors.forename: Yaron S
authors.initials: YS
authors.lastname: Brin
authors.affiliation: Department of Orthopedics, Meir Medical Center, affiliated with Sacker School of Medicine, Tel Aviv University, Kfar Saba, Israel.
authors.forename: Benny
authors.initials: B
authors.lastname: Kish
authors.affiliation: Department of Orthopedics, Meir Medical Center, affiliated with Sacker School of Medicine, Tel Aviv University, Kfar Saba, Israel.
authors.forename: Meir
authors.initials: M
authors.lastname: Nyska
authors.affiliation: Department of Orthopedics, Meir Medical Center, affiliated with Sacker School of Medicine, Tel Aviv University, Kfar Saba, Israel.
authors.forename: Iftach
authors.initials: I
authors.lastname: Hetsroni
mesh_terms: D064386:Ankle Fractures / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery*; D000072039:Fracture Dislocation / Q000000981:diagnostic imaging / Q000601:surgery; D005593:Fracture Fixation, Internal; D006801:Humans; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011184:Postoperative Period; D011859:Radiography; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: ankle fracture; posterior malleolar fragment; postoperative CT; revision surgery; syndesmosis