$spiral fracture tibia$

$spiral fracture tibia$

While these studies were on ankle fractures, there may be a similar issue with PM fractures accompanying tibial shaft fractures. This is important, as several studies on ankle fractures have shown that plain radiographs are not sufficient to provide surgically relevant information. Therefore, CT imaging is necessary to visualize the fragment in size, comminution and articular impaction and for preoperative planning. Several recent publications suggest that surgical fixation-even of small fragments-is important for restoring the articular surface, the fibular notch and trans-syndesmotic stability. The management of fractures of the PM is currently changing. Fractures with an increased risk of PM involvement have already been described several times in the literature. Missed PM fractures can lead to intraoperative complications such as secondary dislocation as well as postoperative instability and post-traumatic osteoarthritis. This is clinically relevant-especially for tibial shaft fractures with a high risk of additional PM fractures-to avoid unnecessary radiation, but at the same time not to overlook any PM fractures. Īlthough the occurrence of PM fractures in tibial shaft spiral fractures is now well established, there is no evidence that plain X-ray imaging is sufficient to rule out additional PM fractures. The incidence of concomitant PM fractures in tibial shaft fractures type A has been cited to be greater than 50%, and importantly, not all of them were detected preoperatively. Trail registration numberĬoncomitant fractures of the posterior malleolus (PM) typically occur in distal tibia fractures (Arbeitsgemeinschaft für Osteosynthesefragen Classification AO:43A) and especially in spiral fractures of the tibial shaft (AO:42/43A) with a fracture line extending from proximal-lateral to distal-medial in the anterior–posterior (AP) view (type A). While experiencing improved accuracy, CT imaging should be included in a comprehensive examination of tibial shaft spiral fractures. Only 17% of PM fractures were identified on plain X-ray and awareness of PM only improved diagnosis by 39%. Inter-rater reliability showed fair agreement (Fleiss-Kappa 0.274, p < 0.001) across all examiners and moderate agreement (Fleiss-Kappa 0.561, p < 0.001) in group 2.

$spiral fracture tibia$

The inner-rater reliability was high with 91.2% agreement. No significant differences were demonstrated between radiologists and trauma surgeons.

$spiral fracture tibia$

Senior physicians recognized slightly more fractures than residents (residents: 13.0 ± 7.79 senior physicians: 16.5 ± 3.70 p = 0.040). However, there were significantly more false positives in the awareness group (2.5 vs. Significantly more fractures were diagnosed/detected (14 vs. With this in mind, 14.8 ± 5.95 posterior malleolus fractures were detected. If the posterior malleolus fracture was named or a CT was requested, the fracture was considered “detected”. Overall, 9.13/25 (SD ± 5.77) PM fractures were diagnosed on X-ray. One group was primed with the incidence of PM fractures and asked to explicitly assess the PM. Each group was tasked to make a diagnosis and/or suggest if further imaging was needed. Methodsĥ0 X-rays showing 42A/B/C and 43A fractures were evaluated by two groups of physicians, each group was comprised of a resident and a fellowship-trained traumatologist or radiologist. This study investigated the hypothesis that plain X-ray is not sufficient for a reliable diagnosis of associated non-displaced PM fractures in tibial shaft spiral fractures. Tibial shaft spiral fractures and fractures of the distal third of the tibia (AO:42A/B/C and 43A) frequently occur with non-displaced posterior malleolus fractures (PM).

$spiral fracture tibia$

Spiral fracture tibia