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Growth plate fractures of the distal tibia: is CT imaging necessary?

  • Basic Science
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Comparison of conventional radiographs (CR) of distal tibial growth plate fractures [Salter–Harris (SH) fracture types I–V/triplane fractures I–III] with computed tomography (CT) as the reference standard and assessment of diagnostic benefit of CT imaging in the affected patients.

Materials and methods

We retrospectively evaluated all growth plate injuries of the distal tibia with complete pre-therapeutic imaging material (CR and CT including MPR) obtained between August 2001 and December 2006. The imaging material was randomised and presented to two radiologists. Fracture of metaphysis, epiphysis and epiphyseal line were noted separately for distal tibia. In case of fracture, involvement of the articular surface, articular dehiscence and ridge formation, subluxation and number of tibial fragments were evaluated. All fractures were classified as SH type I–V or triplane fractures type I–III. Sensitivity, specificity, positive and negative predictive value and overall accuracy of CR were compared to CT.

Results

Thirty-three patients (mean age 14 ± 2 years) were evaluated. CR showed significantly less tibial fragments as compared to CT (1.39 ± 0.75 vs. 1.61 ± 1.25; p = 0.023). The overall accuracy of CR was <90% for fracture involving the metaphysis (82%), dehiscence of the articular surface (64%), ridge formation of the articular surface (61%) and subluxation (79%). The CR evaluation showed differing SH classification in CT in 10/33 cases (30%) with the highest misclassification rates in type-III SH fracture. For evaluation of triplane fractures, CR classification was incorrect in five cases (71%) out of seven. No misclassification occurred in types I and II SH fractures.

Conclusion

The CR of distal tibial growth plate fractures showed a low overall accuracy for articular surface dehiscence, articular ridge formation and subluxation as compared to CT. CT revealed significantly more fragments. It is difficult to correctly classify type III/IV SH fractures and triplane fractures with CR thus emphasising the necessity of using CT in selected patients.

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Abbreviations

CR:

Conventional radiograph

CT:

Computed tomography

MDCT:

Multidetector computed tomography

MPR:

Multiplanar reformation

NPV:

Negative predictive value

PACS:

Picture archiving computer system

PPV:

Positive predictive value

RIS:

Radiology information system

SH:

Salter–Harris

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Acknowledgments

Dr. Heyer was supported by official grants of the Bergmannsheil Bochum (Wissenschaftskommission #01-radio-300 and #2007-radio-568).

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Authors and Affiliations

  1. Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum, Buerkle-de-la-Camp Platz 1, 44789, Bochum, Germany

    Stefan P. Lemburg & Christoph M. Heyer

  2. Children’s University Hospital, Ruhr-University of Bochum, Bochum, Germany

    Eggert Lilienthal

Authors
  1. Stefan P. Lemburg
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  2. Eggert Lilienthal
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  3. Christoph M. Heyer
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Corresponding author

Correspondence to Christoph M. Heyer.

Additional information

S. P. Lemburg and E. Lilienthal contributed equally to this project as co-authors.

The results of this study are part of the doctorial thesis of E. Lilienthal.

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Lemburg, S.P., Lilienthal, E. & Heyer, C.M. Growth plate fractures of the distal tibia: is CT imaging necessary?. Arch Orthop Trauma Surg 130, 1411–1417 (2010). https://doi.org/10.1007/s00402-010-1140-1

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  • DOI: https://doi.org/10.1007/s00402-010-1140-1

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