Abstract
Introduction; Distal tibial physeal fractures are the commonest cause of growth arrest and deformity secondary to failure to achieve and maintain an accurate reduction. Our study compared assessment of displacement and screw placement using X-ray alone compared to CT scans. Methods; 62 consecutive fractures over a 4 year period were used. Displacement was measured on 18 Salter Harris III and IV fractures by 7 surgeons separately using X-rays alone. These measurements were compared to those made from the CT scans. Screw placement was drawn onto tracings of outlines of of single cuts of CT scans by 4 surgeons seperately for all 62 fractures using X-rays alone. This was repeated one week later using the CT scans. Ideal screw placement was considered to perpendicularly bisect the fracture line. Differences between the ideal and observer measurements were analysed using the paired t-test. Results; The surgeons were incorrect in determining whether there was more or less than 2mm of displacement in 33.3 Ð 50% of cases (mean = 38.9%) . There was a statistically signiþcant difference (p < 0.0001) in accuracy of screw insertion point and direction between using X-rays and Ct scans for all surgeons and fracture types. Conclusions; We recommend that CT scans are essential for accurate pre-operative assessment of distal tibial physeal fractures.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
