Computed Tomography's Impact on the Surgical Planning for Posterior Malleolar Fractures

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Resumo

Objetivo

Este estudo teve como objetivo avaliar a influência da tomografia computadorizada (TC) no planejamento pré-operatório das fraturas do maléolo posterior (MP) do tornozelo, comparando suas informações com as de radiografias convencionais (RX) e o seu impacto no tratamento cirúrgico.

Métodos

A pesquisa incluiu 81 pacientes com fraturas do MP, cujas imagens de RX e TC foram analisadas por 33 cirurgiões ortopédicos especializados. O estudo foi dividido em duas etapas, com avaliação de RX na primeira e de RX e TC na segunda. Em ambas as etapas, perguntou-se o tamanho do MP, a estabilidade da fratura, a conduta pré-operatória e as possíveis modificações após avaliar a TC.

Resultados

Os resultados mostraram que, ao considerar apenas o RX, 83,5% dos avaliadores decidiram pela fixação do MP. No entanto, ao adicionar a TC, essa decisão foi modificada em 49,1% dos casos, influenciando a via de acesso cirúrgico e o tipo de osteossíntese. A TC revelou, em 34,7% dos casos, um fragmento maior do MP em comparação ao RX, demonstrando sua superioridade na avaliação do tamanho e morfologia da fratura.

Conclusão

A TC deve ser incluída de forma rotineira no planejamento cirúrgico das fraturas do tornozelo com comprometimento do maléolo posterior, pois permite uma avaliação mais precisa do traço de fratura e pode mudar a decisão terapêutica baseada somente na RX.

Keywords

ankle fractures - radiography - surgeons - tomography, x-ray computed

Palavras-chave

cirurgiões - fraturas do tornozelo - radiografia - tomografia computadorizada por raios x

Authors' Contributions

Each author contributed individually and significantly to the development of this study. NDMN: conceptualization, validation, data collection and analysis, methodology, and paper drafting and writing. PFTN: validation, data collection and analysis, methodology, paper drafting and writing, and table and figure editing and formatting. JMPB: writing and review and table and figure editing and formatting. MTC: writing, review, and editing. RWC: Conceptualization, methodology, and final revision. NRS: conceptualization, methodology, and final revision.

Study developed at the Department of Orthopedics and Traumatology, Santa Casa de São Paulo – Pavilhão “Fernandinho Simonsen”, Faculdade de Ciências Médicas, Santa Casa de São Paulo, Brazil.

Publication History

Received: 13 November 2024

Accepted: 26 May 2025

Article published online:
08 September 2025

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