Reliability of Postoperative Radiographies in Ankle Fractures



1 Department of Orthopedic Surgery, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran- Center for Advanced Orthopedic Studies, BIDMC, Harvard Medical School, Boston, MA, USA

2 Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Orthopedics ,Shohada Tajrish Hospital ,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran ,Iran



Background: The accuracy of reduction of ankle fractures using postoperative plain radiographies (x-ray) remains
widely controversial. Some authors have demonstrated that postoperative computed tomography (CT) scan can be
useful for these patients. In current study, the efficacy of x-rays after fixation of ankle fractures was investigated based
on the CT scan findings.
Methods: A total of 73 patients with ankle fractures who were subjected to open reduction internal fixation (ORIF) were
enrolled. After surgery, if the reduction was acceptable based on the x-rays according to standard measurements, the
patient was referred for CT scanning. Forty four patients were included in the study. Undesirable CT scan findings
including malreduction of fragments or articular surfaces, device malpositioning, missed fractures, and undetected
intra-articular fragments were documented.
Results: Undesirable CT findings were seen in 25 patients (56.8%). CT scan showed acceptable reduction without
device malpositioning in 19 patients. The most prevalent findings in CT images were malreduction and device
malpositioning in 17 and 16 patients, respectively. There was no abnormal finding in CT imaging of lateral malleolar
fractures. In two thirds of the injured syndesmosis, device malpositioning, and malreduction were detected in CT scan.
Conclusion: Despite acceptable postoperative x-rays, a considerable number of patients with ankle fractures had
inappropriate reduction or undesirable findings in their postoperative CT scan. It seems necessary to use CT scan after
ORIF of ankle fractures in order to examine the accuracy of reduction. Further validation of postoperative CT scan in
ankle fracture surgery should be investigated.
Level of evidence: IV