Computed tomography changes diagnosis, management and surgical planning of ankle fractures.

PURPOSE: To demonstrate how the use of adjunctive Computed Tomography (CT) can modify diagnosis, treatment options, and operative planning of ankle fractures in comparison with conventional radiographs (CR) in isolation. MATERIALS AND METHODS: A total of 53 patients diagnosed with an ankle fracture between 2011 and 2016, were assessed with CT and CR. Evaluations of the fractures using CR in isolation and CR combined with CT were compared using different readers. Fractures were assessed in terms of type, displacement, size, associated injuries, treatment, patient position and surgical planning. RESULTS: The medial malleolus fractures characteristics (posteromedial fragment and anterior colliculus), the presence of posterior malleolus fracture and its characteristics (displacement, size, posteromedial or posterolateral segment) (ps < 0.042), syndesmosis injury (p < 0.001), and the absence of deltoid ligament lesion (p < 0.001), were more evident with the combination of CT and radiographs. There was an increase in operative indication (p = 0.007), prone positioning (p = 0.002), posterior malleolus surgical treatment (p < 0.001), posterolateral approach for the lateral malleolus (p = 0.003), and syndesmosis fixation (p = 0.020) with the association of CT and CR, among all groups of expertise, with a high interobserver reliability (> 0.75). CONCLUSIONS: The CR may fail to demonstrate subtle lesions, such as posterior malleolus fractures and syndesmotic injuries. The CT evaluation increases the diagnostic precision and improves the quality of information the surgeon receives, what might positively affect patient care. LEVEL OF EVIDENCE III: Retrospective Comparative Study.

Wiberg's center-edge angle in patients with slipped capital femoral epiphysis.

Wiberg's center-edge (CE) angle was measured in 104 patients with slipped capital femoral epiphysis (SCFE) to determine whether it correlates with a deeper acetabulum. Initially, the radiographs of 45 pre- and mild slip patients (group I) were measured using the contour of the femoral head to determine the head center (point C) as described by Wiberg's original article and, alternatively, using the acetabular line (Visser's method). In addition, the radiographs of 59 patients with moderate and severe slip (group II) were measured in both ways. The measurements were not statistically different between both methods and between the two groups. In 78 unilateral slips, the Mann-Whitney test did not show statistical differences between the normal side and the affected hip (p > 0.05). The Wiberg's CE angle of 58 patients was compared with that of a group control of the same age, gender, and race. The Wiberg's CE angle was significantly higher in patients with SCFE (p < 0.05), the same being true when comparing the white and nonwhite patients separately (p < 0.05 and p < 0.05, respectively). Theories involving biomechanical stress in the adolescent hip can explain the majority of slips occurring in an otherwise healthy child. The femoral head with a better coverage yields more shearing stress across the epiphyseal line. This, associated with hormonal disorders, trauma, or another deleterious factor, can progress to its failure.