Postoperative monitoring of distal intraarticular radial fractures treated with osteosynthesis by means of multislice CT

• Published in: RöFo : Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebende Verfahren Vol. 183; no. 2; p. 120
• Main Authors: Lorenzen, M, Wedegärtner, U, Weber, C, Adam, G, Lorenzen, J
• Format: Journal Article
• Language: English
• Published: Germany 01-02-2011
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bone Plates; Bone Wires; External Fixators; Female; Fracture Fixation, Internal; Fracture Healing - physiology; Fractures, Malunited - diagnostic imaging; Fractures, Malunited - surgery; Humans; Image Processing, Computer-Assisted; Intra-Articular Fractures - diagnostic imaging; Intra-Articular Fractures - surgery; Male; Middle Aged; Postoperative Complications - diagnostic imaging; Postoperative Complications - surgery; Radius Fractures - diagnostic imaging; Radius Fractures - surgery; Reoperation; Sensitivity and Specificity; Tomography, Spiral Computed; Wrist Injuries - diagnostic imaging; Wrist Injuries - surgery; Young Adult
• ISSN: 1438-9010
• DOI: 10.1055/s-0029-1245569

This study evaluates multislice CT (MSCT) for the postsurgical control of intraarticular fractures of the distal radius.
In 131 patients conventional X-rays in two planes and MSCT were performed. In a consensus process two experienced radiologists judged conventional X-ray and computed tomography images in a random view. The correct position of the osteosynthetic material was assessed and it was ascertained whether an articular surface incongruity, a gap between two fracture fragments, or an intraarticular bone element was detectable. For each point of evaluation a confidence level of the evaluation was assessed on a five-point scale.
Ninety patients were classified as having correct alignment and osteosynthesis according to conventional X-ray, while when using the findings from axial CT scans only, 82 patients, and after the addition of multiplanar re-constructions (MPR) only 73 patients were found to have almost proper alignment and osteosynthesis. In 42 patients dehiscence of the fragments was diagnosed with MSCT, but was not visualized by X-ray, leading to surgical revision in eight patients, confirming the diagnosis. In five patients an intraarticular position of intraarticular material was confirmed with MSCT and surgical revision. A significant advantage for the evaluation confidence level was achieved for MPRs in comparison with axial CT scans and X-ray.
The marked diagnostic advantage with a high evaluation confidence level in comparison with conventional X-ray methods justify the use of MSCT during postoperative monitoring of articular radial fractures treated with osteosynthesis.