Comparison of radiography and computed tomography in emergency department evaluation of ankle trauma
Comparison of radiography and computed tomography in emergency department evaluation of ankle trauma
Aim: The aim of this study was to compare computed tomography (CT) and radiography (XR) images of patients presented to theemergency department with ankle trauma and undergone CT imaging, and to describe the fractures for which XR is insufficient andthe characteristics of these fractures.Material and Methods: This retrospectively designed study included patients presented to the emergency department with ankletrauma between January 2016 and December 2017. Patients who had ankle trauma, who performed XR and CT imaging wereincluded in the study. The XR and CT images were reinterpreted by a radiologist.Results: Three hundred and sixteen patients were enrolled in the study. Of the patients, 137 (43.4%) had fracture on XR and 168(53.2%) had fracture on CT. The most common bone fractures were detected lateral malleolus and distal tibia fractures. Thesensitivity and specificity of XR in detecting fracture compared to CT were 75% and 93%, respectively. Sixty-three (20%) of thepatients had two simultaneous fractures. The sensitivity and specificity of XR in detecting two simultaneous fractures were 56%and 94%, respectively. Twelve (3.8%) of the patients had distal tibial, medial malleolus and lateral malleolus fractures (trimalleolarfracture). The sensitivity and specificity of XR in detecting trimalleolar fracture were 17% and 100%, respectively.Conclusion: XR has a low sensitivity in identifying ankle fractures. The sensitivity is much lower in cases of two simultaneousfractures and trimalleolar fractures. Therefore, CT imaging should be preferred in patients with complex ankle injuries.
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- 1. Mehta SS, Rees K, Cutler L, et al. Understanding risks and
complications in the management of ankle fractures. Indian
J Orthop 2014;48:445-52.
- 2. Tartaglione JP, Rosenbaum AJ, Abousayed M, et al.
Classifications in brief: lauge-hansen classification of ankle
fractures. Clin Orthop Relat Res 2015;473:3323-8.
- 3. Pinto A, Berritto D, Russo A, et al. Traumatic fractures
in adults: missed diagnosis on plain radiographs in the
emergency department. Acta Biomed 2018;89:111-23.
- 4. Caracchini G, Pietragalla M, De Renzis A, et al. Talar
fractures: radiological and CT evaluation and classification
systems. Acta Biomed 2018;89:151-65.
- 5. Chen Y, Zhang K, Qiang M, et al. Comparison of plain
radiography and CT in postoperative evaluation of ankle
fractures. Clin Radiol 2015;70:e74-82.
- 6. Gibson PD, Bercik MJ, Ippolito JA, et al. The role of computed
tomography in surgical planning for trimalleolar fracture. a
survey of ota members. J Orthop Trauma 2017;31:e116-e20.
- 7. Black EM, Antoci V, Lee JT, et al. Role of preoperative
computed tomography scans in operative planning for
malleolar ankle fractures. Foot Ankle Int 2013;34:697-704.
- 8. Haapamaki VV, Kiuru MJ, Koskinen SK. Ankle and foot
injuries: analysis of MDCT findings. AJR Am J Roentgenol
2004;183:615-22.
- 9. Kozaci N, Ay MO, Avci M, et al. The comparison of point-ofcare
ultrasonography and radiography in the diagnosis of
tibia and fibula fractures. Injury 2017;48:1628-35.
- 10. Allen SD, Harvey CJ, O’Regan D. Interpretation of ankle and
foot radiographs. Br J Hosp Med (Lond) 2006;67:8-11.
- 11. Caracchini G, Pietragalla M, De Renzis A, et al. Talar
fractures: radiological and CT evaluation and classification
systems. Acta Biomed 2018;89:151-65.
- 12. Meunier B, Joskin J, Gillet P, et al. Mécanisme et imageriedes
fractures de la cheville. Rev Med Liège 2010;66:9:491-7.
- 13. Barile A, Bruno F, Arrigoni F, et al. Emergency and trauma of
the ankle. Semin Musculoskelet Radiol 2017;21:282-9.
- 14. Mulligan ME. Ankle and foot trauma. Semin Musculoskelet
Radiol 2000;4:241-53.
- 15. Sowman B, Radic R, Kuster M, et al. Distal tibio fibular
radiological overlap: Does it always exist? Bone Joint Res
2012;1:20-4.
- 16. Lemburg SP, Lilienthal E, Heyer CM. Growth plate fractures
of the distal tibia: is CT imaging necessary? Arch Orthop
Trauma Surg 2010;130:1411-7.
- 17. Hwang JS, Koury KL, Gorgy G, et al. Evaluation of intraarticular
fracture extension after gunshot wounds to
the lower extremity: plain radiographs versus computer
tomography. J Orthop Trauma 2017;31:334-8.
- 18. Tornetta P, Gorup J. Axial computed tomography of pilon
fractures. Clin Orthop Relat Res 1996;273-6.
- 19. Yeung TW, Chan CY, Chan WC, et al. Canpre-operative axial
CT imaging predict syndesmosis instability in patients
sustaining ankle fractures? Seven years’ experience in a
tertiary trauma center. Skeletal Radiol 2015;44:823-9.
- 20. Ebraheim NA, Lu J, Yang H, et al. Radiographic and CT
evaluation of tibio fibular syndesmotic diastasis: a cadaver
study. Foot Ankle Int 1997;18:693-8.
- 21. Dikos GD, Heisler J, Choplin RH, et al. Normal tibio fibular
relationships at the syndesmosis on axial CT imaging. J
Orthop Trauma 2012;26:433-8.
- 22. Linsenmaier U, Brunner U, Schöning A, et al. Classification
of calcaneal fractures by spiral computed tomography:
implications for surgical treatment. Eur Radiol 2003;13:2315-
22.
- 23. Badillo K, Pacheco JA, Padua SO, et al. Multidetector
CT evaluation of calcaneal fractures. Radiographics
2011;31:81-92.
- 24. Angthong C, Atikomchaiwong A, Yoshimura I, et al. Does the
addition of computed tomography to computed radiography
provide more value to final outcomes and treatment
decisions in displaced intra-articular calcaneal fractures? J
Med Assoc Thai 2014;97:S1-9.