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To identify the incidence of distal joint fractures in a series of distal shaft fractures of the third tibia and to report the utility of both computed tomography (CT) and radiographic investigation reports of the distal extension of the fractures in the articular surface of the tibia (RIDEFAST) for identification of joint involvement.
Level 1 trauma center.
Four hundred and seventeen patients with fractures of the distal diaphysis of the third tibia were included in the study.
Intramedullary fixation by nail or plate.
Main outcome measures:
Type of joint fracture, time of diagnosis and RIDEFAST ratios.
One hundred and one of 417 distal third fractures (24%) had a fracture of the articular surface of the distal tibia. Of these 101 fractures, 41 (41%) represented an extension of the primary fracture line and 60 (59%) were distinct malleolar fractures. Of the 101 joint fractures, 95 (94%) were identified preoperatively and 6 (6%) were identified intraoperatively. Of the 95 fractures identified preoperatively, 87 (92%) were identified on standard radiographs and 8 (8%) by computed tomography. Thirty-five preoperative CT scans were performed on diaphyseal fractures of the distal third of the tibia looking for an intra-articular fracture. In 27 patients (77%), no joint fractures were present, representing an overall yield of 23% among CT scans performed to exclude joint fracture in distal third tibial fractures. The RIDEFAST ratios for the 101 distal tibial shaft fractures with joint involvement and 100 fractures without joint involvement were not significantly different (P> 0.05) using both coronal and sagittal measurements.
CT scans performed on diaphyseal fractures of the distal third of the tibia looking for joint fractures had a low yield (23%). The widespread use of computed tomography to diagnose fractures of the articular surface of the distal tibia in the setting of fractures of the distal tibial shaft does not appear to be justified. No statistically significant difference in the RIDEFAST ratios was found between fractures with and without joint involvement, indicating that more work is required before RIDEFAST can be used to reliably rule out joint involvement in this setting.
Level of proof:
Diagnostic level III. See Instructions for Authors for a full description of the levels of evidence.