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Computed Tomography in the Diagnosis and Treatment of Ankle Fractures

A Critical Analysis Review

Rammelt, Stefan, MD, PhD1; Boszczyk, Andrzej, MD, PhD2

doi: 10.2106/JBJS.RVW.17.00209
Review Articles with Critical Analysis Component

  • * Good-quality lateral and mortise radiographs are the standard for diagnosing ankle fractures and control of reduction.
  • * Preoperative computed tomography (CT) imaging should be utilized generously for malleolar fractures with an unstable syndesmosis (including osseous avulsions), fractures involving the posterior malleolus, supination-adduction-type fractures with suspected medial plafond impaction, spiral fractures of the distal part of the tibial shaft, and transitional ankle fractures in adolescents.
  • * The strict application of the established 2-dimensional radiographic criteria described by Weber and direct visual control of syndesmotic reduction enable the surgeon to prevent most clinically relevant malreductions.
  • * Intraoperative 3-dimensional imaging within limitations (missing contralateral side, lower resolution) and postoperative CT scanning are useful for detecting relevant malreduction and other findings that may go unnoticed on radiographs, especially rotatory malalignment, intra-articular implants, loose bodies, and marginal joint impaction.
  • * Relevant malalignment should be corrected as early as possible after detection in order to avoid joint incongruity and chronic syndesmotic instability leading to posttraumatic ankle arthritis. Although the potentially deleterious consequences of malreduction in the treatment of ankle fractures are well known, few studies on postoperative CT imaging have shown a direct impact on clinical decision-making.

1University Center for Orthopaedics & Traumatology, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany

2Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education, Prof. Adam Gruca Clinical Hospital, Otwock, Poland

E-mail address for S. Rammelt:

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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