De Marchi Neto Noé, Nesello Pietro Felice Tomazini, Bergamasco Jordanna Maria Pereira, Costa Marco Túlio, Christian Ralph Walter, Severino Nilson Roberto
Department of Orthopedics and Traumatology, Santa Casa de São Paulo - Pavilhão Fernandinho Simonsen, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil.
Rev Bras Ortop (Sao Paulo). 2025 Sep 8;60(3):1-9. doi: 10.1055/s-0045-1810040. eCollection 2025 Jun.
This study aimed to evaluate the influence of computed tomography (CT) on the preoperative planning of posterior malleolus (PM) fractures of the ankle, comparing its information with that of conventional radiographs and assessing its impact on surgical treatment.
The study included 81 patients with PM fractures, whose radiological and CT images were analyzed by 33 specialized orthopedic surgeons. The study had two stages, with a radiological assessment on the first, and the second having radiological plus CT evaluation. In both stages, we asked surgeons about the PM size, fracture stability, preoperative management, and potential modifications after CT analysis.
Considering only radiographs, 83.5% of the evaluators selected PM fixation. However, CT addition modified this choice in 49.1% of the cases, influencing the surgical access route and the type of osteosynthesis. In 34.7% of cases, CT revealed a larger PM fragment than radiographs, demonstrating that it is superior in evaluating fracture size and morphology.
The surgical planning of ankle fractures with PM involvement should routinely include CT scans for a more precise fracture line assessment and a potential change in the therapeutic decision based on simple radiography alone.
本研究旨在评估计算机断层扫描（CT）对踝关节后踝（PM）骨折术前规划的影响，将其信息与传统X线片进行比较，并评估其对手术治疗的影响。
该研究纳入了81例PM骨折患者，其放射学和CT图像由33名专业骨科医生进行分析。该研究分为两个阶段，第一阶段进行放射学评估，第二阶段进行放射学加CT评估。在两个阶段中，我们都询问了外科医生关于PM的大小、骨折稳定性、术前处理以及CT分析后的潜在改变。
仅考虑X线片时，83.5%的评估者选择了PM固定。然而，增加CT后，49.1%的病例改变了这一选择，影响了手术入路和骨固定类型。在34.7%的病例中，CT显示的PM碎片比X线片更大，表明其在评估骨折大小和形态方面更具优势。
涉及PM的踝关节骨折的手术规划应常规包括CT扫描，以便更精确地评估骨折线，并根据单纯X线片可能改变治疗决策。
