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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
97° CONGRESS OF THE PIEDMONTESE-LIGURIAN-LOMBARD SOCIETY OF ORTHOPEDICS AND TRAUMATOLOGY (SPLLOT) - II (Alba, September 22-23, 2000)
Minerva Ortopedica e Traumatologica 2000 October;51(5):301-6
Difficult traumatology: the ankle (pilon of the tibia). Radiographic assessment
Sabatino C., Ferrero G., Torasso G.
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Background. A correct diagnosis of tibial pilon fractures represents a key point for the treatment. The authors's aim is to evaluate the efficacy of the traditional radiology and of the other methods currently available, by analysing the imaging of their own cases and the literature on this topic.
Methods. 19 cases of tibial pilon fractures personally treated from 1994 to march 2000 have been examined critically. These cases have been compared to the indications pointed out in surveys made during last years.
Results. According to the first approach in the Emergency Unit it is necessary to carry out at least four radiographic views: A-P, L-L, internal and external oblique. After the patient's hospitalization the diagnosis is completed by either tomography or CT scan; the latter is conclusive in order to classify the lesion and helps significantly the preoperative planning. On the contrary, MRI is not able to modify significantly the diagnosis and consequently the treatment of these fractures, above all the acute ones; M.R.I. can have an important role in the medium-long term evaluation and in the rare cases of fatigue fractures.
Conclusions. The successful treatment of a serious lesion such as the tibial pilon fracture is connected to the correct execution of the above mentioned radiograms. The preoperative planning based on CT scan allows a reasonable choice of the surgical approach and of the appropriate surgical technique; as a consequence, it entails a reduction in terms of surgical time and use of the image intensifier.