Diagnosing Fractures of the Distal Tibial Articular Surface
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A Study was conducted to identify the incidence of distal articular fractures in a series of distal third tibia shaft fractures and to report the utility of both computed tomography (CT) scans and Radiographic Investigation of the Distal Extension of Fractures into the Articular Surface of the Tibia (RIDEFAST) ratios for identification of articular involvement.

417 patients with distal third tibia shaft fractures were included in the study.

--101 of the 417 distal third fractures had a fracture of the distal tibia articular surface. Of these 101 fractures, 41 represented an extension of the primary fracture line and 60 were separate malleolar fractures.

--Of the 101 articular fractures, 95 were identified preoperatively and 6 were identified intraoperatively. Of the 95 fractures identified preoperatively, 87 were identified on plain radiographs and 8 by CT scan.

--35 preoperative CT scans were performed on distal third tibia shaft fractures in search of an intra-articular fracture.

--In 27 patients, no articular fracture was present, representing an overall yield of 23% among CT scans performed to rule out an articular fracture in distal third tibia shaft fractures.

--RIDEFAST ratios for all 101 distal tibia shaft fractures with articular involvement and 100 fractures with no articular involvement were not significantly different using both coronal and sagittal plane measurements.

Conclusively, CT scans done on distal third tibia shaft fractures to look for articular fractures yielded a low number of results (23 percent ). The widespread use of CT scan to identify distal tibia articular surface fractures in the context of distal tibia shaft fractures does not appear to be justified. RIDEFAST ratios showed no statistically significant differences between fractures with and without articular involvement.

Source: https://journals.lww.com/jorthotrauma/Abstract/2021/09000/Diagnosing_Fractures_of_the_Distal_Tibial.7.aspx