Myatt, Darren, Stringer, Howard, Chapman, James 
ORCID: 0000-0002-4489-550X, Fischer, Ben and Mason, Lyndon ORCID: 0000-0002-0371-3183
(2022)
Prediction of distal tibial articular extension in tibial shaft fractures: both posterior malleolar fracture and non posterior malleolar fracture intra-articular extension.
European Journal of Trauma and Emergency Surgery, 49 (2).
pp. 903-910.
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Abstract
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Multiple authors have highlighted the increased incidence of occult posterior malleolar fractures (PMFs) with spiral tibial shaft fractures, although other reported associated risks of intra-articular extension have been limited. The aim of our study is to investigate both PMFs and non-PMFs intra-articular extensions associated with tibial diaphyseal fractures to try to determine any predictive factors.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>We undertook a retrospective review of a prospectively collected database. The inclusion criteria for this study were any patient who had sustained a diaphyseal tibial fracture, who had undergone surgery during the study period and who had also undergone a CT scan in addition to plain radiographs. The study time period for this study was between 01/01/2013 and 9/11/2021.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Out of 764 diaphyseal fractures identified, 442 met the inclusion criteria. A total of 107 patients had PMF extensions (24.21%), and a further 128 patients (28.96%) had intra-articular extensions that were not PMF’s. On multivariate analysis, spiral tibial fracture subtypes of the AO/OTA classification (OR 4.18, <jats:italic>p</jats:italic> < 0.001) and medial direction of tibial spiral from proximal to distal (OR 4.38, <jats:italic>p</jats:italic> < 0.001) were both significantly associated with PMF. Regarding intra-articular fractures, multivariate analysis showed significant associations with non-spiral (OR 4.83, <jats:italic>p</jats:italic> < 0.001) and distal (OR 15.32, <jats:italic>p</jats:italic> < 0.001) tibial fractures and fibular fractures that were oblique (OR 2.01, <jats:italic>p</jats:italic> = 0.019) and at the same level as tibia fracture (OR 1.83, <jats:italic>p</jats:italic> = 0.045) or no fracture of the fibular (OR 7.02, <jats:italic>p</jats:italic> < 0.001).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>In our study, distal tibial articular extension occurs in almost half of tibial shaft fractures. There are very few fracture patterns that are not associated with some type of intra-articular extension, and therefore, a low threshold for preoperative CT should be maintained.</jats:p> </jats:sec><jats:sec> <jats:title>Level of evidence</jats:title> <jats:p>4.</jats:p> </jats:sec>
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Tibial shaft, Tibial diaphysis, Posterior malleolar fracture, Intra-articular extension, Prediction, CT |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences > School of Medicine |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 15 Dec 2022 09:27 |
| Last Modified: | 12 May 2023 00:43 |
| DOI: | 10.1007/s00068-022-02156-x |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3166674 |
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