Bonnie Y Chien, Eitan M Ingall, Steven Staffa, Caroline Williams, Christopher P Miller, John Y Kwon
{"title":"SER-II型踝关节骨折是解剖性的吗?计算机断层扫描显示在表面正常的x线片上出现榫槽错位。","authors":"Bonnie Y Chien, Eitan M Ingall, Steven Staffa, Caroline Williams, Christopher P Miller, John Y Kwon","doi":"10.1177/19386400221093861","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Ankle fracture treatment is predicated on minimal displacement, leading to abnormal joint contact area. The purpose of this investigation is to determine whether computed tomography (CT) detects subtle mortise malalignment undetectable by x-ray in supination-external rotation-II (SER-II) injuries.</p><p><strong>Methods: </strong>A total of 24 patients with SER-II injuries, as demonstrated by negative gravity stress radiography, were included. Medial clear space (MCS) measurements were performed on bilateral ankle x-rays (injured and contralateral, uninjured side) at several time points as well as bilateral non-weight-bearing CT performed once clinical and radiographic healing was demonstrated (mean = 66 days post injury, range = 61-105 days). Statistical analyses examined differences in measurements between both sides.</p><p><strong>Results: </strong>Final x-rays demonstrated no differences between normal and injured ankle MCS (P = .441). However, CT coronal/axial MCS measurements were different (P < .05). CT coronal MCS measured wider by a mean difference of 0.67 mm (P < .001).</p><p><strong>Conclusion: </strong>There is a high incidence of subtle mortise malalignment in SER-II ankle fractures, as demonstrated by CT, which is undetectable when assessed by plain radiographs. Although clinical outcomes are yet unknown, there are important implications of the finding of confirmed, subtle mortise malalignment in SER-II injuries and the limitations of x-ray to detect it.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Are SER-II Ankle Fractures Anatomic? Computed Tomography Demonstrates Mortise Malalignment in the Setting of Apparently Normal Radiographs.\",\"authors\":\"Bonnie Y Chien, Eitan M Ingall, Steven Staffa, Caroline Williams, Christopher P Miller, John Y Kwon\",\"doi\":\"10.1177/19386400221093861\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Ankle fracture treatment is predicated on minimal displacement, leading to abnormal joint contact area. The purpose of this investigation is to determine whether computed tomography (CT) detects subtle mortise malalignment undetectable by x-ray in supination-external rotation-II (SER-II) injuries.</p><p><strong>Methods: </strong>A total of 24 patients with SER-II injuries, as demonstrated by negative gravity stress radiography, were included. Medial clear space (MCS) measurements were performed on bilateral ankle x-rays (injured and contralateral, uninjured side) at several time points as well as bilateral non-weight-bearing CT performed once clinical and radiographic healing was demonstrated (mean = 66 days post injury, range = 61-105 days). Statistical analyses examined differences in measurements between both sides.</p><p><strong>Results: </strong>Final x-rays demonstrated no differences between normal and injured ankle MCS (P = .441). However, CT coronal/axial MCS measurements were different (P < .05). CT coronal MCS measured wider by a mean difference of 0.67 mm (P < .001).</p><p><strong>Conclusion: </strong>There is a high incidence of subtle mortise malalignment in SER-II ankle fractures, as demonstrated by CT, which is undetectable when assessed by plain radiographs. Although clinical outcomes are yet unknown, there are important implications of the finding of confirmed, subtle mortise malalignment in SER-II injuries and the limitations of x-ray to detect it.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":39271,\"journal\":{\"name\":\"Foot and Ankle Specialist\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2022-05-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Foot and Ankle Specialist\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/19386400221093861\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Foot and Ankle Specialist","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/19386400221093861","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Are SER-II Ankle Fractures Anatomic? Computed Tomography Demonstrates Mortise Malalignment in the Setting of Apparently Normal Radiographs.
Background: Ankle fracture treatment is predicated on minimal displacement, leading to abnormal joint contact area. The purpose of this investigation is to determine whether computed tomography (CT) detects subtle mortise malalignment undetectable by x-ray in supination-external rotation-II (SER-II) injuries.
Methods: A total of 24 patients with SER-II injuries, as demonstrated by negative gravity stress radiography, were included. Medial clear space (MCS) measurements were performed on bilateral ankle x-rays (injured and contralateral, uninjured side) at several time points as well as bilateral non-weight-bearing CT performed once clinical and radiographic healing was demonstrated (mean = 66 days post injury, range = 61-105 days). Statistical analyses examined differences in measurements between both sides.
Results: Final x-rays demonstrated no differences between normal and injured ankle MCS (P = .441). However, CT coronal/axial MCS measurements were different (P < .05). CT coronal MCS measured wider by a mean difference of 0.67 mm (P < .001).
Conclusion: There is a high incidence of subtle mortise malalignment in SER-II ankle fractures, as demonstrated by CT, which is undetectable when assessed by plain radiographs. Although clinical outcomes are yet unknown, there are important implications of the finding of confirmed, subtle mortise malalignment in SER-II injuries and the limitations of x-ray to detect it.