Comparison of two plain radiographic and 3D-based measurement methods for posterior malleolar fragment size in trimalleol ankle fractures

Year 2020, Volume: 5 Issue: 1, 11 - 15, 20.03.2020

Güray Altun Hatice Çatal Reis Bülent Bayram Gürsel Saka

https://doi.org/10.25000/acem.641188

Cited By: 1

Abstract

Aim: The aim of this study is, to compare the posterior malleolar fragment (PMF) sizing between lateral ankle radiography measurement and computer assistted 3D modelling (CA3DM) methods
Methods: Fifty-one patients between january 2015 and november 2018 with posterior malleolar fractured were included in this study. The rate of PMF to the articular surface at the distal end of the tibia was calculated by two different imaging methods by two surgeons. According to posterior fragment size, patients were separated into two groups. Group 1 was consisted of posterior fragment size smaller than 15% and group 2 was bigger than 15% due to CA3DM.
Results: The interobserver correlation (IOC) between two observers and CA3DM was 44.3%. Also the IOC between first observer and CA3DM was 35.7% (p<0.05), second observer and CA3DM were 46.6% (p<0.01) and observers was 51.6% (p<0.01). For group 1, IOC between two observers and CA3DM was 41.2% (p<0.05), first observer and CA3DM was 30.6% (p>0.05), second observer and CA3DM was 51.6% (p<0.05) and two observers were 45.8% (p<0.05). For group 2, IOC between two observers and CA3DM was 27.9% (p>0.05), first and CA3DM was 18.6% (p>0.05), second observer and CA3DM was 7.1% (p>0.05) and two observers was 49% (p<0.05).
Conclusion: Our study shows that posterior malleolar fragment size measuring on plain radiography is not a safe method for bigger fragments and CA3DM method may be a more reliable to assess correct fragment size and also to analyze fracture morphology. But for fragments ≤15% CA3DM and plain radiographic measures are not statistically different.

Keywords

ankle fractures, posterior malleolar fractures, trimalleolar fractures

Trimalleoller ayak bileği kırıklarında posterior malleol fragmanın ölçümü için 3D temelli ölçüm metodlarıyla ile iki boyutlu radyoragrafi metodunun karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı, posterior malleol fragman (PMF) boyutunun ayak bileği lateral grafisi üzerinden ölçüm ve bilgisayar destekli 3D modelleme (BD3DM) yöntemleri kullanılarak boyutlarının karşılaştırılmasıdır.
Yöntemler: Ocak 2015 ve kasım 2018 yılları arasında posterior malleol kırığı olan 51 hasta çalışmaya dahil edildi. PMF boyutunun distal tibia eklem yüzeyine oranı iki farklı yöntem ile ve iki cerrah tarafından hesaplandı. Posterior fragman boyutuna göre hastalar iki gruba ayrıldı. BD3DM yöntemine göre group 1 PMF boyutu % 15’ten küçük ve group 2 % 15’ten büyük olanlardan oluşmaktaydı.
Bulgular: İki cerrah ve BD3DM arasında interobserver uyum % 44.3, birinci cerrah ve BD3DM % 35.7 (p<0.05), ikinci cerrah ve BD3DM % 46.6 (p<0.01) ve iki cerrah ile % 51.6 (p<0.01) idi. Birinci grupta iki cerrah ve BD3DM arasındaki uyum % 41.2 (p<0.05) ve birinci cerrah ile BD3DM arasında ise %30.6 (p>0.05)‘ idi. İkinci cerrah ve BD3DM arasındaki uyum % 51.6 (p<0.05) ve iki cerrahın kendi aralarındaki uyumu % 45.8 (p<0.05)‘ idi. İkinci grupta iki cerrah ve BD3DM arasındaki uyum % 27.9 (p>0.05) ve birinci cerrah ile BD3DM arasında ise %18.6 (p>0.05)‘ idi. İkinci cerrah ve BD3DM arasındaki uyum %7.1 (p>0.05) ve her iki cerrahın kendi aralarındaki uyumu %49 (p<0.05) olarak bulundu.
Sonuç: Çalışmamız göstermiştir ki posterior malleol fragmanın radiografik yöntemle ölçümü >%15’ten büyük fragmanlar için güvenilir bir yöntem değildir. BD3DM yöntemi ise gerçek fragman boyutunu hesaplamada güvenilir bir yöntemdir. Fakat ≤ % 15’ten küçük fragmanlar için iki yöntem arasında istatistiksel fark saptanmamıştır. 

Keywords

Ayak bileği kırığı, posterior malleol kırığı, trimalleol kırığı

References

• 1. Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures – an increasing problem? Acta Orthop Scand. 1998;69:43-7.
• 2. Jaskulka RA, Ittner G, Schedl R. Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. J Trauma. 1989;29:1565-70.
• 3. McDaniel WJ, Wilson FC. Trimalleolar fractures of the ankle. An end result study. Clin Orthop Relat Res. 1977;122:37-45.
• 4. Langenhuijsen JF, Heetveld MJ, Ultee JM. Results of ankle fractures with involvement of the posterior tibial margin. J Trauma. 2002;53:55-60.
• 5. Van den Bekerom MP, Haverkamp D, Kloen P. Biomechanical and clinical evaluation of posterior malleolar fractures. A systematic review of the literature. J Trauma. 2009;66:279-84.
• 6. Abdelgawad AA, Kadous A, Kanlic E. Posterolateral approach for treatment of posterior malleolus fracture of the ankle. J Foot Ankle Surg. 2001;50:607-11.
• 7. Ferries JS, DeCoster TA, Firoozbakhsh KK, Garcia JF, Miller RA. Plain radio¬graphic interpretation in trimalleolar ankle fractures poorly assesses posterior fragment size. J Orthop Trauma. 1994;8:328-31.
• 8. Büchler L, Tannast M, Bonel HM, Weber M. Reliability of Radiologic Assessment of the Fracture Anatomy at the Posterior Tibial Plafond in Malleolar Fractures, J Orthop Trauma. 2009;23:208-12.
• 9. de Muinck Keizer RO, Meijer DT, van der Gronde Ba, Teunis T, Stufkens SA, Kerkhoffs GM, Goslings JC, Doornberg JN. Articular Gap and Step off Revisited: 3D Quantification of Operative Reduction for Posterior Malleolar Fragments. J Orthop Trauma. 2016;30:670-5.
• 10. Haraguchi N, Haruyama H, Toga H, Kato F. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg Am. 2006;88:1085-92.
• 11. Bartoníček J, Rammelt S, Kostlivý K Vaněček V, Klika D, Trešl I. Anatomy and classification of the posterior tibial fragment in ankle fractures, Arch Orthop Trauma Surg. 2015;135:505-16.
• 12. Tejwani NC, Pahk B, Egol KA. Effect of posterior malleolus fracture on outcome after unstable ankle fracture. J Trauma. 2010;69:666-9.
• 13. Odak S, Ahluwalia R, Unnikrishnan P, Hennessy M, Platt S. Management of posterior malleolar fractures: a systematic review. J Foot Ankle Surg. 2016;55:140-5.
• 14. Ono A, Nishikawa S, Nagao A, Irie T, Sasaki M, Kouno T. Arthroscopically assisted treatment of ankle fractures: arthroscopic findings and surgical outcomes. Arthroscopy. 2004;20:627-31.
• 15. Drijfhout van Hooff CC, Verhage SM, Hoogendoorn JM. Influence of Fragment Size and Postoperative Joint Congruency on Long-Term Outcome of Posterior Malleolar Fractures, Foot Ankle Int. 2015;36:673-8.
• 16. Gardner MJ, Streubel PN, McCormick JJ, Klein SE, Johnson JE, Ricci WM. Surgeon practices regarding operative treatment of posterior malleolus fractures. Foot Ankle Int. 2011;32:385-93.
• 17. Ebraheim NA, Mekhail AO, Haman SP. External Rotation-Lateral View of the Ankle in the Assessment of the Posterior Malleolus Foot Ankle Int. 1999;20:379-83.
• 18. Meijer DT, Doornberg JN, Mallee WH, van Dijk CN, Kerkhoffs GM, Stufkens SA. Guesstimation of posterior malleolar fractures on plain lateral radiographs. Injury. 2015;46:2024-9.
• 19. Miniaci-Coxhead SL, Martin EA, Ketz JP. Quality and utility of immediate formal postoperative radiographs in ankle fractures. Foot Ankle Int. 2015;36:1196-201.
• 20. Gonzalez O, Fleming JJ, Meyr AJ. Radiographic assessment of posterior malleo¬lar ankle fractures. J Foot Ankle Surg. 2015;36:1196-201.
• 21. Evers J, Barz L, Wähnert D, Grüneweller N, Raschke MJ, Ochman S. Size matters: The influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures Injury. 2015;46:S109-13.