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Journal of Bone and Joint Surgery - British Volume, Vol 86-B, Issue 2,
239-243.
doi: 10.1302/0301-620X.86B2.13624 Copyright © 2004 by British Editorial Society of Bone and Joint Surgery Do CT scans aid assessment of distal tibial physeal fractures?L. Cutler, FRCS ED (Trauma and Orth)SpR Mersey Rotation, c/o A. Bass, Alder Hey Hospital, Eaton Road, Liverpool L12 2AP, UK. A. Molloy, FRCS SpR Mersey Rotation, Leighton Hospital, Middlewich Road, Crewe, Cheshire CW1 4QJ, UK. V. Dhukuram, FRCS, SHO in Orthopaedics Wishaw General Hospital, 90 Netherton Street, Wishaw ML2 0DP, UK. A. Bass, FRCS (Trauma Orth), Consultant Orthopaedic Surgeon Alder Hey Hospital, Eaton Road, Liverpool L12 2AP, UK. Correspondence should be sent to Miss L. Cutler at 1 Fairfield Gardens, Stockton Heath, Warrington WA4 2BX, UK. Distal tibial physeal fractures are the second most common growth plate injury and the most common cause of growth arrest and deformity. This study assesses the accuracy of pre-operative planning for placement of the screws in these fractures using either standard radiographs or CT scans. We studied 62 consecutive physeal fractures over a period of four years. An outline of a single cut of the CT scan was used for each patient. An ideal position for the screw was determined as being perpendicular to and at the midpoint of the fracture. The difference in entry point and direction of the screw between the ideal and the observers’ assessments were compared using the paired Student’s t-test. There was a statistically significant improvement (p < 0.0001) in the accuracy of the point of insertion and the direction of the screw on the pre-operative plan when CT scans were used rather than plain radiographs. We would, therefore, recommend that CT scans are routinely used in the pre-operative assessment and treatment of distal tibial physeal fractures.
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