title: Computed Tomography Assessment of Peroneal Tendon Displacement and Posteromedial Structure Entrapment in Pilon Fractures.
abstract: OBJECTIVE
  To determine the proportion of (1) peroneal tendon displacement (PTD) and posteromedial structure entrapment (PMSE) cases in a sample of pilon fractures, (2) missed diagnoses of PTD and PMSE on computed tomography (CT) by radiologists and attending orthopaedic trauma surgeons, and PTD and PMSE cases by (3) OTA/AO classification, and (4) fibular fracture.
  
  
  METHODS
  Retrospective cohort review.
  
  
  METHODS
  Regional level 1 Trauma Center.
  
  
  METHODS
  Two hundred patients treated between July 2008 and November 2014.
  
  
  METHODS
  Axial and reconstructed CT images were used in bone and soft tissue windows to identify PTD and PMSE.
  
  
  METHODS
  Medical charts were reviewed to identify OTA/AO fracture classification, the presence of concomitant fibular fracture, whether radiologist CT interpretation noted PTD or PMSE, and whether attending orthopaedic trauma surgeons' operative notes mentioned recognition of and management of PTD or PMSE.
  
  
  RESULTS
  From the retrospective review of CT, PTD was identified in 11.0% and PMSE in 19.0% of all pilon fractures. Of the 22 patients with PTD, 59.1% sustained a concomitant fibular fracture and 90.9% sustained a 43-C fracture. Patients with PTD sustained more 43-C fractures (90.9% vs. 62.9%) but significantly fewer fibular fractures (59.1% vs. 80.3%; P = 0.023) than patients without PTD. Of the 38 patients with PMSE, 81.6% sustained a fibular fracture and 86.8% sustained a 43-C fracture. PMSE was more common in patients with 43-C fractures (86.8% vs. 61.1%). The final preoperative radiologist CT interpretation commented on PTD and PMSE in 50.0% of cases.
  
  
  CONCLUSIONS
  Higher energy pilon fractures (43-C) are associated with higher incidence of PMSE and PTD. Concomitant fibula fracture may play a protective role in PTD in the setting of pilon fractures. Both attending radiologists and attending orthopaedic trauma surgeons frequently fail to recognize the diagnoses of PTD and PMSE.
  
  
  METHODS
  Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; and †Division of Environment and Public Health, Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Alex
authors.initials: A
authors.lastname: Fokin
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Huntley
authors.forename: Spencer H
authors.initials: SH
authors.lastname: Summers
authors.forename: Charles M
authors.initials: CM
authors.lastname: Lawrie
authors.forename: Alejandro D
authors.initials: AD
authors.lastname: Miranda
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Caban-Martinez
authors.forename: Steven D
authors.initials: SD
authors.lastname: Steinlauf
mesh_terms: D000328:Adult; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000601:surgery; D005431:Florida / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D053682:Tendon Entrapment / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D013708:Tendon Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D013978:Tibial Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome