Seong-Eun Byun; Sang-June Lee; Uk Kim; Young Rak Choi; Soo-Hong Han; Byong-Guk Kim

doi:10.12671/jkfs.2016.29.2.114

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Original Article
Usefulness of Computed Tomography on Distal Tibia Intra-Articular Fracture Associated with Spiral Tibia Shaft Fracture: Seong-Eun Byun, M.D., Sang-June Lee, M.D., Uk Kim, M.D., Young Rak Choi, M.D., Soo-Hong Han, M.D., Ph.D., Byong-Guk Kim, M.D., Ph.D.; Journal of the Korean Fracture Society 2016;29(2):114-120.
DOI: https://doi.org/10.12671/jkfs.2016.29.2.114
Published online: April 19, 2016

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

^*Department of Orthopaedic Surgery, CHA Gumi Medical Center, CHA University, Gumi, Korea.

Address reprint requests to: Byong-Guk Kim, M.D., Ph.D. Department of Orthopaedic Surgery, CHA Gumi Medical Center, 12 Sinsi-ro 10-gil, Gumi 39295, Korea. Tel: 82-31-780-5289, Fax: 82-31-708-3578, bgkimmd@gmail.com

• Received: July 6, 2015 • Revised: December 11, 2015 • Accepted: January 10, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
NOTES
REFERENCES

Abstract

Purpose
The purpose of this study is to evaluate the usefulness of computed tomography (CT) for spiral tibia shaft fracture by analyzing associated distal tibia intra-articular fractures diagnosed by CT only which met the indication of surgical fixation and were fixed.
Materials and Methods
Ninety-five spiral tibia shaft fractures with preoperative ankle plain radiographs and CT were analyzed retrospectively. The incidence and type of associated distal tibia articular fractures were evaluated by reviewing ankle plain radiography and CT. The number of fractures diagnosed by CT that correspond with the indication of fixation and that were actually fixed were analyzed.
Results
Among 95 spiral tibia shaft fractures, 62 cases (65.3%) were associated with distal tibia intra-articular fracture. There were 37 cases of posterior malleolar fracture, 5 cases of avulsion fracture of the distal anterior tibiofibular ligament, 5 cases of medial malleolar fracture, and 15 cases of complex fracture. Among 52 posterior malleolar fractures including complex fracture, 20 cases were diagnosed by ankle plain radiograph. Of these 20 cases, 16 posterior malleolar fractures (80.0%) met the indication of surgical fixation, and 14 cases were actually fixed with a screw. Among 32 posterior malleolar fractures diagnosed by CT only, 26 cases (81.3%) met the indication of surgical fixation and 18 cases (56.3%) were fixed by screw.
Conclusion
Approximately 50% of associated fractures were diagnosed by CT only and more than 80% of associated posterior malleolar fractures met the indication of surgical fixation and among these fractures, 18 cases (56.3%) were actually fixed by screw. This result suggests that CT is useful in diagnosis and treatment of distal tibia intra-articular fracture associated with spiral tibia shaft fracture.
Key words: Tibia fracture, Intra-Articular fracture, Posterior malleolus fracture, Computed tomography

None.

REFERENCES

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4. Purnell GJ, Glass ER, Altman DT, Sciulli RL, Muffly MT, Altman GT. Results of a computed tomography protocol evaluating distal third tibial shaft fractures to assess noncontiguous malleolar fractures. J Trauma, 2011;71:163-168.Article
5. Schottel PC, Berkes MB, Little MT, et al. Predictive radiographic markers for concomitant ipsilateral ankle injuries in tibial shaft fractures. J Orthop Trauma, 2014;28:103-107.Article
6. van der Werken C, Zeegers EV. Fracture of the lower leg with involvement of the posterior malleolus; a neglected combination? Injury, 1988;19:241-243.Article
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8. Stuermer EK, Stuermer KM. Tibial shaft fracture and ankle joint injury. J Orthop Trauma, 2008;22:107-112.Article
9. Kim JW, Choi HJ, Lee DH, Kim YC. Ankle fracture associated with tibia shaft fractures. J Korean Fract Soc, 2014;27:136-143.Article
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Fig. 1

Measurement of relative length of posterior malleolar fragment. A: anteroposterior length of articular surface, B: anteroposterior length of posterior malleolar fragment.

Fig. 2

(A) Preoperative tibia anteroposterior (AP) and lateral image of a 61-year-old male with an AO/OTA 42-A1 type fracture. (B) Preoperative ankle AP and lateral image showing a lateral malleolar fracture and no associated distal tibia intra-articular fracture. (C) Axial image of computed tomography showing a minimally displaced posterior malleolar fracture exceeding 25% of the articular surface and an avulsion fracture of the anterior tibiofibular ligament. (D) AP and lateral image after plating with screw fixation of the posterior malleolar fragment and Kirschner wire fixation of the avulsion fracture of the anterior tibiofibular ligament.

Fig. 3

(A) Preoperative tibia anteroposterior (AP) and lateral image of a 51-year-old female with an AO/OTA 42-A1 type fracture. (B) Preoperative ankle AP and lateral image showing no associated distal tibia intra-articular fracture. (C) Axial image of computed tomography showing a minimally displaced posterior malleolar fracture exceeding 25% of the articular surface. (D) AP and lateral image after intramedullary nailing with fixation of the posterior malleolar fragment.

Table 1

Types of Associated Distal Tibia Intra-Articular Fracture in Tibia Shaft Fracture

Variable	PM fracture	ATFL avulsion fracture	MM fracture	Combined fracture	Total
Plain radiograph	15^*	5^*	5	5	30
CT	23	5	0	4	32
Total	37^*	5^*	5	15^*	62

Values are presented as number only. *One posterior malleolar fracture and 5 anterior tibio-fibular ligament avulsion fractures diagnosed by plain radiograph were revealed as combined injuries after reviewing computed tomography and classified as combined fracture in 'total' line. PM: Posterior malleolus, ATFL: Anterior tibio-fibular ligament, MM: Medial malleolus, CT: Computed tomography.

Table 2

Component of Associated Combined Fractures

	PM & ATFL avulsion fracture	PM & MM fracture	MM & ATFL avulsion fracture
No. of combined fracture	12	3	0

PM: Posterior malleolus, ATFL: Anterior tibio-fibular ligament, MM: Medial malleolus.

Table 3

Comparison between PM Diagnosed by Plain Radiograph and CT

Variable	Diagnosed by radiograph (n=20)	Diagnosed by CT (n=32)
PM mets indication of surgical fixation	16	26
PM fragment size >25%	16	26
PM >2 mm of gap	2	0
PM fixed	14	18

Values are presented in number only. PM: Posterior malleolar fracture, CT: Computed tomography.

Figure & Data

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Treatment of Distal Tibial Spiral Fractures Combined with Posterior Malleolar Fractures
Young Sung Kim, Ho Min Lee, Jong Pil Kim, Phil Hyun Chung, Soon Young Park
Journal of the Korean Orthopaedic Association.2021; 56(4): 317. CrossRef

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Usefulness of Computed Tomography on Distal Tibia Intra-Articular Fracture Associated with Spiral Tibia Shaft Fracture

J Korean Fract Soc. 2016;29(2):114-120. Published online April 30, 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.2.114

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Usefulness of Computed Tomography on Distal Tibia Intra-Articular Fracture Associated with Spiral Tibia Shaft Fracture

Fig. 1 Measurement of relative length of posterior malleolar fragment. A: anteroposterior length of articular surface, B: anteroposterior length of posterior malleolar fragment.

Fig. 2 (A) Preoperative tibia anteroposterior (AP) and lateral image of a 61-year-old male with an AO/OTA 42-A1 type fracture. (B) Preoperative ankle AP and lateral image showing a lateral malleolar fracture and no associated distal tibia intra-articular fracture. (C) Axial image of computed tomography showing a minimally displaced posterior malleolar fracture exceeding 25% of the articular surface and an avulsion fracture of the anterior tibiofibular ligament. (D) AP and lateral image after plating with screw fixation of the posterior malleolar fragment and Kirschner wire fixation of the avulsion fracture of the anterior tibiofibular ligament.

Fig. 3 (A) Preoperative tibia anteroposterior (AP) and lateral image of a 51-year-old female with an AO/OTA 42-A1 type fracture. (B) Preoperative ankle AP and lateral image showing no associated distal tibia intra-articular fracture. (C) Axial image of computed tomography showing a minimally displaced posterior malleolar fracture exceeding 25% of the articular surface. (D) AP and lateral image after intramedullary nailing with fixation of the posterior malleolar fragment.

Fig. 1

Fig. 2

Fig. 3

Usefulness of Computed Tomography on Distal Tibia Intra-Articular Fracture Associated with Spiral Tibia Shaft Fracture

Table 1

Types of Associated Distal Tibia Intra-Articular Fracture in Tibia Shaft Fracture

Variable	PM fracture	ATFL avulsion fracture	MM fracture	Combined fracture	Total
Plain radiograph	15^*	5^*	5	5	30
CT	23	5	0	4	32
Total	37^*	5^*	5	15^*	62

Table 2

Component of Associated Combined Fractures

	PM & ATFL avulsion fracture	PM & MM fracture	MM & ATFL avulsion fracture
No. of combined fracture	12	3	0

PM: Posterior malleolus, ATFL: Anterior tibio-fibular ligament, MM: Medial malleolus.

Table 3

Comparison between PM Diagnosed by Plain Radiograph and CT

Variable	Diagnosed by radiograph (n=20)	Diagnosed by CT (n=32)
PM mets indication of surgical fixation	16	26
PM fragment size >25%	16	26
PM >2 mm of gap	2	0
PM fixed	14	18

Values are presented in number only. PM: Posterior malleolar fracture, CT: Computed tomography.

Table 1 Types of Associated Distal Tibia Intra-Articular Fracture in Tibia Shaft Fracture

Table 2 Component of Associated Combined Fractures

PM: Posterior malleolus, ATFL: Anterior tibio-fibular ligament, MM: Medial malleolus.

Table 3 Comparison between PM Diagnosed by Plain Radiograph and CT

Values are presented in number only. PM: Posterior malleolar fracture, CT: Computed tomography.