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.
Sixty-two consecutive fractures over a four-year period were used. Displacement was measured on 18 Salter Harris III and IV fractures by seven surgeons separately using X-rays alone. These were compared to measurements from the CT scans. Screw placement was drawn onto outlines of single cuts of CT scans by four surgeons 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.
The surgeons were incorrect in determining whether there was more or less than 2mm of displacement in 33.3 – 50% of cases (mean = 38.9% ). There was a statistically significant difference (p <
0.0001) in accuracy of screw placement between using X-Rays and CT scans for all surgeons.
We recommend that CT scans are essential for accurate pre-operative assessment of distal tibial physeal fractures.
