Role of the CT Scan in Preoperative Planning for Tillaux-Chaput Fractures in Adults

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dc.catalogadorvzp
dc.contributor.authorMassri Pugin, Jafet Esteban
dc.contributor.authorMatamoro Rueda, Gabriel
dc.contributor.authorMorales, Sergio
dc.contributor.authorMery, Pablo
dc.contributor.authorLira, María Jesús
dc.contributor.authorFilippi, Jorge
dc.date.accessioned2025-05-12T12:57:03Z
dc.date.available2025-05-12T12:57:03Z
dc.date.issued2025
dc.description.abstractBackground: Tillaux-Chaput fractures (TCFs) occur in the anterolateral rim of the distal tibia. TCFs are often overlooked on radiographic review, increasing the risk of chronic pain, instability, and ankle osteoarthritis. This study evaluated the effect of the computed tomography (CT) scan on preoperative planning for TCFs in adults.Methods: A retrospective review of ankle fractures evaluated from 2013 to 2023 at a university hospital was conducted. The inclusion criteria were patients ≥18 years of age who underwent radiographic and CT evaluation and had a TCF that was confirmed by CT. The exclusion criteria included pilon and distal tibial fractures and prior ankle surgery. Three orthopaedic surgeons assessed radiographs, classified TCFs using the Rammelt classification, formulated a treatment plan (conservative versus surgical), and, if a surgical treatment was indicated, determined the patient positioning, fixation type, and approach for the TCF. After evaluating CT images, changes in treatment strategy were recorded. Forward stepwise regression was utilized to analyze variables associated with modifications in preoperative planning.Results: A total of 481 fractures had ankle radiographs and CT scans; of these, 83 (17.3%) had a TCF. After the CT evaluation, the Rammelt classification and the surgical decision changed by 69.1% and 12.5%, respectively. Changes in patient positioning, the type of fixation, and the surgical approach for a TCF (when surgery was indicated) occurred in 32.1%, 43.8%, and 35.3% of all cases, respectively. Multivariable analysis showed that the detection of a TCF on CT predicted changes in the surgical decision and fixation type, while changes in the TCF classification predicted modifications in the fixation type and surgical approach. Posterior malleolar fractures were the unique predictor of changes in the patient positioning.Conclusions: CT evaluation modified the surgical decision, type of fixation, and surgical approach for a TCF in 12.5%, 43.8%, and 35.3% of cases, respectively. Moreover, the detection of a TCF and a change in the classification after CT evaluation were predictors of a change in treatment strategy. These findings underscore the importance of the CT scan in the preoperative planning for TCFs in adults. Therefore, we strongly recommend conducting a CT scan when a TCF is suspected in adult patients.Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
dc.fuente.origenORCID
dc.identifier.doi10.2106/JBJS.24.01111
dc.identifier.urihttps://doi.org/10.2106/JBJS.24.01111
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/104125
dc.information.autorucEscuela de Medicina; Morales Diaz, Sergio Luis; 0000-0002-7766-4097; 1035705
dc.information.autorucEscuela de Medicina; Massri Pugin, Jafet Esteban; S/I; 1095388
dc.information.autorucEscuela de Medicina; Matamoros Rueda, Gabriel; S/I; 1211267
dc.language.isoen
dc.nota.accesocontenido parcial
dc.rightsacceso restringido
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods10 Reduced inequalities
dc.subject.odspa10 Reducción de las desigualdades
dc.titleRole of the CT Scan in Preoperative Planning for Tillaux-Chaput Fractures in Adults
dc.typeartículo
sipa.codpersvinculados1035705
sipa.codpersvinculados1095388
sipa.codpersvinculados1211267
sipa.trazabilidadORCID;2025-05-07
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