The Journal of Bone and Joint Surgery, Vol 67, Issue 9 1388-1395, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
A comparison of conventional radiography and computed tomography in the evaluation of spiral fractures of the tibia
DH Gershuni, MJ Skyhar, B Thompson, D Resnick, G Donald and WH Akeson
Spiral fractures of the distal third of the tibial shaft can have problems
of malunion or non-union that may be related to inability to assess the
quality of the initial reduction of the fracture. We created typical
two-fragment torsional tibial fractures in cadaver bones. The fracture
fragments were mounted in a specially constructed jig that allowed
simulation of various malreduction positions including varus and valgus
angulation, antecurvatum, recurvatum, malrotation, and shortening.
Anteroposterior and lateral radiographs and computed tomographic scans of
the specimens were made. Measurements of the fracture gap were made at
defined distances along the fractures, directly on the specimens as well as
on the radiographs and computed tomographic scans. Excellent correlation
was obtained between measurements of the gap on the specimens and on the
computed tomographic scans, but plain radiographic measurements in thirty
of thirty-four instances underestimated the true width of the gap. When
shortening was introduced larger maximum gaps (of as much as eighteen
millimeters) as well as greater discrepancies between measurements on the
scans and plain radiographs were seen. The sizes of the fracture gaps were
also greater for a given degree of shortening when the pitch of the spiral
fracture was greater.
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