Postoperative Monitoring of Distal Intraarticular Radial Fractures Treated with Osteosynthesis by means of Multislice CT

 

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Zusammenfassung

Ziel: Evaluation der Wertigkeit der Multislice-CT (MSCT) bei der postoperativen Kontrolle intraartikulärer distaler Radiusfrakturen. Material und Methoden: Bei 131 Patienten wurde eine konventionelle Röntgenaufnahme in 2 Ebenen und eine MSCT durchgeführt. Die Bilder der beiden Verfahren wurden geblindet von 2 erfahrenen Radiologen im Konsensusprozess befundet. Die Materiallage der Osteosynthese und Stellung der knöchernen Elemente wurde bestimmt und bewertet, ob eine Gelenkstufe, eine Lücke zwischen 2 Frakturenden oder ein intraartikuläres Knochenelement abgrenzbar waren. Anhand einer 5-Punkte-Skala musste die Sicherheit der Diagnose festgelegt werden. Ergebnisse: Bei 90 Patienten war im konventionellen Röntgen eine regelrechte Stellung und Materiallage diagnostiziert worden, wohingegen anhand der axialen CT-Bilder bei 82 Patienten und nach Durchsicht der multiplanaren Rekonstruktionen nur bei 73 Patienten eine korrekte Materiallage und Stellung diagnostiziert wurde. In 42 Fällen wurde eine Frakturdehiszenz nur anhand der MSCT festgestellt. Bei 8 Patienten führte diese Diagnose zur Operation mit Bestätigung des Befunds. In 5 Fällen wurde eine intraartikuläre Lage von Osteosynthesematerial nur mithilfe der MSCT diagnostiziert, die operativ verifiziert wurde. Ein signifikanter Vorteil in der Sicherheit der Diagnosestellung konnte für die multiplanaren CT-Rekonstruktionen im Vergleich zu den axialen CT-Bildern und den Röntgenaufnahmen nachgewiesen werden. Schlussfolgerung: Die MSCT erweist sich aufgrund der hohen diagnostischen Zusatzinformationen als Methode der Wahl in der postoperativen Kontrolle osteosynthetisch versorgter distaler Radiusfrakturen mit artikulärer Beteiligung.

Abstract

Purpose: This study evaluates multislice CT (MSCT) for the postsurgical control of intraarticular fractures of the distal radius. Materials and Methods: In 131 patients conventional X-rays in two planes and MSCT were performed. In a consensus process two experienced radiologists judged conventional X-ray and computed tomography images in a random view. The correct position of the osteosynthetic material was assessed and it was ascertained whether an articular surface incongruity, a gap between two fracture fragments, or an intraarticular bone element was detectable. For each point of evaluation a confidence level of the evaluation was assessed on a five-point scale. Results: Ninety patients were classified as having correct alignment and osteosynthesis according to conventional X-ray, while when using the findings from axial CT scans only, 82 patients, and after the addition of multiplanar re-constructions (MPR) only 73 patients were found to have almost proper alignment and osteosynthesis. In 42 patients dehiscence of the fragments was diagnosed with MSCT, but was not visualized by X-ray, leading to surgical revision in eight patients, confirming the diagnosis. In five patients an intraarticular position of intraarticular material was confirmed with MSCT and surgical revision. A significant advantage for the evaluation confidence level was achieved for MPRs in comparison with axial CT scans and X-ray. Conclusion: The marked diagnostic advantage with a high evaluation confidence level in comparison with conventional X-ray methods justify the use of MSCT during postoperative monitoring of articular radial fractures treated with osteosynthesis.

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PD Dr. Jörn Lorenzen

Department of Radiology, University of Hamburg

Martinistr. 52

20246 Hamburg

Germany

Phone: ++ 49/40/4 28 03 40 10

Fax: ++ 49/40/4 28 03 47 59

Email: lorenzen@uke.uni-hamburg.de