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Topic:

Triplane Fracture

Issue:

Ankle

Category:

Trauma

Title:

Metaphyseal Fracture Displacement is Predictive of Intra-articular Diastasis in Adolescent Triplane Ankle Fractures

Author:

Greenhill, Dustin A. MD; Mundluru, Surya N. MD; Gomez, Robert W. MD; Romero, Joseph MD; Riccio, Anthony I. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

February 2024

Reference:

44(2): p 94-98, DOI: 10.1097/BPO.0000000000002530

Level Of Evidence:

III

# of Patients:

87

Study Type:

Retrospective cohort study

Location:

Level 1 pediatric trauma center

Summary:

This study investigates the relationship between articular displacement as seen on conventional X-rays (XR) and CT scans in triplane fractures, and identifies whether metaphyseal displacement on a lateral XR can predict clinically significant intra-articular displacement that may require surgery.

Methods:

The study performed a retrospective review of consecutive triplane fractures over a 10-year period. Displacement of the articular surface and metaphyseal bone was measured from both XR and CT images. The study compared XR and CT measurements to assess whether XR could predict clinically relevant articular displacement that would require surgery.

Exclusions:

Not specified

Results:

XR vs. CT: XR underestimated articular displacement by 229% in the sagittal plane (1 mm on XR vs. 3.3 mm on CT) and 17% in the coronal plane (2.3 mm on XR vs. 2.7 mm on CT), with the underestimation of articular step-off being significant in both planes (P < 0.05). Surgical vs. non-surgical: CT was more reliable in distinguishing which patients required surgery. Metaphyseal displacement was higher in patients with articular displacement ≥2.5 mm on CT (P = 0.001). Predictive value: Sixty patients had metaphyseal displacement >1 mm on lateral XR, with 56 of these showing surgical-magnitude articular displacement on CT (positive predictive value = 94%).

Conclusions:

Conventional XR often underestimates the true articular displacement of triplane fractures. Metaphyseal displacement >1 mm on a lateral XR is strongly predictive of clinically relevant articular displacement seen on CT. This finding should prompt further imaging, such as CT, to guide management decisions, particularly for potential surgical intervention.

Relevance:

Limitations:

Perspective:

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