Importance of computed tomography in posterior malleolar fractures: Added information to preoperative X-ray studies

Figure 1 Measurement of the size of a posterior malleolus fracture fragment in a profile X-ray image. The proportion between the fracture and the total articular surface, i.e. the a/(a + b) ratio, was evaluated.

Figure 2 Measurement of a posterior malleolus fracture fragment in a sagittal tomography slice R. Similarly to what was completed for X-ray images, the proportion between the fracture and the total articular surface, i.e. the a/(a + b) ratio, was evaluated.

Figure 3 Axial computed tomography scan posterior malleolus measure. A: The sagittal plane; B: The corresponding axial slice was selected 5 mm above the highest point of the tibial articular surface; C: In the axial image, the tibial articular surface; D: The area corresponding to the posterior malleolus fracture was measured; E: Thus, the x/(x + y) ratio was used to obtain the percentage of the tibial plafond surface (axial view) involved in the posterior malleolus.

Figure 4 Comparative size of posterior malleolus on X-rays and axial computed tomography scan according to the Haraguchi classification. A: The percent size of the posterior malleolus measured in profile X-ray images according to Haraguchi classification; B: The percent size of the posterior malleolus measured in axial tomography images according to the Haraguchi classification. A statistically significant difference was found only when compared to Haraguchi 3. No difference was found between Haraguchi 1 and 2 (P < 0.001). PMXR: Posterior malleolus size in profile X-ray images; AXCT: Axial computed tomography slice of the posterior malleolus.

Figure 5 The distribution of the percent area of the tibial plafond of the posterior malleolus fracture according to the various Haraguchi classification types. Blue: Group A; Red: Group B; PMXR: Posterior malleolus size in profile X-ray images; AXCT: Axial computed tomography slice of the posterior malleolus; PM: Posterior malleolus.