SavedAdd your journal

Journals / Ağrı Tıp Fakültesi Dergisi / 2025 / Cilt: 3 Sayı: 3

Comparison of treatment options based on X-ray and computed tomography findings in patients presenting to the emergency department with foot and ankle trauma

Acil servise başvuran ayak ve ayak bileği travmalı hastalarda tedavi seçeneklerinin X-ray ve bilgisayarlı tomografi bulgularına göre karşılaştırılması

Burcu Özen Karabulut(AGRI IBRAHIM CECEN UNIVERSITY)0000-0002-9046-6511
Mehmet Reşit Öncü(VAN YÜZÜNCÜ YIL ÜNİVERSİTESİ)0000-0001-9296-2554
Pages
122–129
Publication Date
2025-10-29
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Particularly, CT is valuable in detecting injuries missed by X-ray, not only informing initial treatment decisions at admission but also providing important predictive value for subsequent treatment modifications.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Aim: This study investigated the differences between direct radiography (X-ray) and computed tomography (CT) in detecting pathological findings in patients presenting to the emergency department with foot and/or ankle trauma and evaluated their role in predicting treatment requirements and modifications.
📊
Key Findings & Data:Materials and Methods: The study was conducted at the Emergency Department of Van Yüzüncü Yıl University Faculty of Medicine between January 1, 2017, and December 31, 2019.
💡
Conclusion & Impact:Particularly, CT is valuable in detecting injuries missed by X-ray, not only informing initial treatment decisions at admission but also providing important predictive value for subsequent treatment modifications.
🔬Design:Araştırma Makalesi
📍Scope:2017 Verileri
⚙️Variables:Acil servis · Ayak travması · Ayak bileği travması

Abstract

Aim: This study investigated the differences between direct radiography (X-ray) and computed tomography (CT) in detecting pathological findings in patients presenting to the emergency department with foot and/or ankle trauma and evaluated their role in predicting treatment requirements and modifications. Materials and Methods: The study was conducted at the Emergency Department of Van Yüzüncü Yıl University Faculty of Medicine between January 1, 2017, and December 31, 2019. CT and X-ray results, along with clinical data of patients with foot and/or ankle trauma, were retrospectively analyzed. Results: Imaging revealed pathology only on CT in 8.9% of cases, on both CT and X-ray in 24.9%, while the remaining patients had normal imaging results. The mean Glasgow Coma Scale score was significantly lower in patients with pathology detected on both modalities (p = 0.018). Patients with CT-only findings were more frequently treated with splinting/casting, whereas surgical intervention rates were significantly higher in those with pathology on both imaging modalities (p < 0.001). Furthermore, the need for treatment modification was markedly greater in patients with CT-only pathology compared to other groups (p < 0.001). Conclusion: In the management of foot and ankle trauma in the emergency setting, selecting the appropriate imaging modality plays a critical role in enhancing diagnostic accuracy and guiding proper treatment. Particularly, CT is valuable in detecting injuries missed by X-ray, not only informing initial treatment decisions at admission but also providing important predictive value for subsequent treatment modifications.

Özet

Amaç: Bu çalışmada, ayak ve/veya ayak bileği travması ile acil servise başvuran hastalarda direkt radyografi (X-ray) ve bilgisayarlı tomografinin (BT) patolojik bulguları saptamadaki farklılıklarının, tedavi gereksinimi ve değişimini öngörmedeki rolü araştırıldı. Gereçler ve Yöntemler: Çalışma, Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi Acil Servisi’nde 1 Ocak 2017–31 Aralık 2019 tarihleri arasında gerçekleştirildi. Ayak ve/veya ayak bileği travması olan hastaların BT ve X-ray sonuçları ile klinik verileri retrospektif olarak değerlendirildi. Bulgular: Görüntüleme sonuçlarına göre hastaların %8,9’unda yalnızca BT’de, %24,9’unda ise hem X-ray hem BT’de patoloji saptanırken geri kalan grupta görüntüleme sonuçları normaldi. Hem X-ray hem BT’de patoloji bulunan olgularda Glasgow Koma Skoru ortalaması daha düşük saptandı (p=0,018). Yalnızca BT’de patoloji tespit edilen olgular, daha sık alçı/atel ile tedavi edilirken; her iki görüntülemede patoloji saptananlarda cerrahi girişim oranı anlamlı olarak daha yüksekti (p<0,001). Ayrıca sadece BT’de patoloji saptanan olgularda tedavi değişikliği gereksinimi diğer gruplara göre belirgin şekilde fazlaydı (p<0,001). Sonuç: Acil serviste ayak ve ayak bileği travmalarının yönetiminde doğru görüntüleme yönteminin seçilmesi, tanısal doğruluğu artırarak uygun tedaviye yön vermede kritik bir rol oynar. Özellikle X-ray ile saptanamayan patolojilerin BT ile ortaya konması, başvuru anında uygulanacak tedavi seçeneğinin belirlenmesinde yol gösterici olmasının yanı sıra tedavi değişikliği gereksinimini öngörmede de önemli katkı sağlayabilir.

🔖

Cite This Article

Karabulut, B. Ö., Öncü, M. R. (2025). Comparison of treatment options based on X-ray and computed tomography findings in patients presenting to the emergency department with foot and ankle trauma. Ağrı Tıp Fakültesi Dergisi, Cilt: 3 Sayı: 3, 122–129. https://doi.org/10.61845/agrimedical.1787537

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (46)

  1. Zhao E, Carney D, Chambers M, Ewalefo S, Hogan, M. The role of biologic in foot and ankle trauma-a review of the literature. Curr Rev Musculoskelet Med. 2018;11(3): 495–502.
  2. Barile A, Bruno F, Arrigoni F, et al. Emergency and trauma of the ankle. Semin Musculoskelet Radiol. 2017;21(3):282–289.
  3. Mo K, Gupta A, Singh P, et al. Emergency department visits for ankle fractures through COVID-19: an analysis of the National Electronic Injury Surveillance System. Foot Ankle Orthop. 2022;7(3):24730114221119188.
  4. Mascio A, Greco T, Comisi C, et al. Foot and ankle trauma: Epidemiology before, during, and post covıd-19 pandemic in a level ı trauma center: A 5-year experience and data analysis. J Clin Med. 2024;13(24):7585.
  5. Goldstein CL, Schemitsch E, Bhandari M, Mathew G, Petrisor BA. Comparison of different outcome instruments following foot and ankle trauma. Foot Ankle Int. 2010;31(12):1075–1080.
  6. Thomas AC, Hubbard-Turner T, Wikstrom EA, Palmieri-Smith RM. Epidemiology of posttraumatic osteoarthritis. J Athl Train. 2017;52(6):491–496.
  7. Godoy-Santos AL, de Cesar C, Santini S, Herrera-Pérez M, Valderrabano V, Rammelt S. Pathophysıology of posttraumaticankle osteoarthrıtıs: a multıcenter perspectıve. Acta Ortop Bras. 2024;32(3):e282286.
  8. De Marchi Neto N, Nesello PFT, Bergamasco JM, Costa MT, Christian RW, Severino NR. Importance of computed tomography in posterior malleolar fractures: Added information to preoperative X-ray studies. World J Orthop. 2023;14(12):868–877.
  9. Johnson PT, Fayad LM, Fishman EK. Sixteen-slice CT with volumetric analysis of foot fractures. Emerg Radiol. 2006;12(4):171–176.
  10. Avcı M, Kozacı N, Yüksel S, Etli I, Yilmaz Y. Comparison of radiography and computed tomography in emergency department evaluation of ankle trauma. Ann Med Res. 2019;26:867-872.
  11. Addala TE, Greffier J, Hamard A, et al. Early results of ultra-low-dose CT-scan for extremity traumas in emergency room. Quant Imaging Med Surg. 2022;12(8):4248–4258.
  12. Kalantar SH, Bagheri N, Milan N, et al. Evaluation of treatment planning discrepancies: CT versus plain radiographic findings in patients with foot and ankle trauma. BMC Res Notes. 2024;17(1): 238.
  13. Allen SD, Harvey CJ, O'Regan D. Interpretation of ankle and foot radiographs. Br J Hosp Med (Lond). 2006; 67(1): M8–M11.
  14. Caracchini G, Pietragalla M, De Renzis A, et al. Talar fractures: radiological and CT evaluation and classification systems. Acta Biomed. 2018;89(1-S):151–165.
  15. Sarter M, Krane F, Hockmann J, Leschinger T, Müller LP, Harbrecht A. How Valuable is the CT? Assessment of the Presence of Posterior Malleolar Fractures in Plane Radiographs. Foot Ankle Spec. 2025;14:19386400251351516.
  16. Black EM, Antoci V, Lee JT, et al. Role of preoperative computed tomography scans in operative planning for malleolar ankle fractures. Foot Ankle Int. 2013;34(5):697–704.
  17. Gibson PD, Bercik MJ, Ippolito JA, et al. The role of computed tomography in surgical planning for trimalleolar fracture. A survey of ota members. J Orthop Trauma. 2017;31(4):e116–e120.
  18. Tartaglione JP, Rosenbaum AJ, Abousayed M, DiPreta JA. Classifications in brief: Lauge-hansen classification of ankle fractures. Clin Orthop Relat Res. 2015;473(10):3323–3328.
  19. Mulligan M. E. (2000). Ankle and foot trauma. Seminars in musculoskeletal radiology, 4(2), 241–253.
  20. Hwang JS, Koury KL, Gorgy G, et al. Evaluation of intra-articular fracture extension after gunshot wounds to the lower extremity: plain radiographs versus computed tomography. J Orthop Trauma. 2017;31(6):334–338.
  21. Chen Y, Zhang K, Qiang M, Li H, Dai H. Comparison of plain radiography and CT in postoperative evaluation of ankle fractures. Clin Radiol. 2015;70(8): e74–e82.
  22. Angthong C, Atikomchaiwong A, Yoshimura I, et al. Does the addition of computed tomography to computed radiography provide more value to final outcomes and treatment decisions in displaced intra-articular calcaneal fractures? J Med Assoc Thai. 2014;97(9):S1–S9.
  23. Kocan J, Joseph E, Mercado P, Haider MN, Pavlesen S, Rohrbacher B. (2024). Computed Tomography Scans and Fixation Rates for Trimalleolar Ankle Fractures Over 10 Years at a Level 1 Trauma Center. Foot Ankle Orthop. 2024;9(1): 24730114231216984.
  24. Nenopoulos A, Beslikas T, Gigis I, Sayegh F, Christoforidis I, Hatzokos I. The role of CT in diagnosis and treatment of distal tibial fractures with intra-articular involvement in children. Injury. 2015;46(11): 2177–2180.
  25. Liporace FA, Yoon RS, Kubiak EN, et al. Does adding computed tomography change the diagnosis and treatment of Tillaux and triplane pediatric ankle fractures? Orthopedics. 2012;35(2):e208–e212.
  26. Leung KH, Fang CX, Lau TW, Leung FK. Preoperative radiography versus computed tomography for surgical planning for ankle fractures. J Orthop Surg (Hong Kong). 2016;24(2), 158–162.
  27. Donohoe S, Alluri RK, Hill JR, Fleming M, Tan E, Marecek G. Impact of Computed Tomography on Operative Planning for Ankle Fractures Involving the Posterior Malleolus. Foot Ankle Int. 2017;38(12):1337–1342.
  28. Meijer DT, Doornberg JN, Sierevelt IN, et al. Guesstimation of posterior malleolar fractures on lateral plain radiographs. Injury. 2015;46(10):2024–2029.
  29. Jubel A, Faymonville C, Andermahr J, Boxberg S, Schiffer G. Einschränkungen der Aussagekraft des konventionellen Röntgenbilds bei Sprunggelenksfrakturen im Alter [Conventional X-Rays of Ankle Joint Fractures in Older Patients are Not Always Predictive]. Z Orthop Unfall. 2017;155(1):45–51.
  30. Mangnus L, Meijer DT, Stufkens SA, et al. Posterior malleolar fracture patterns. J Orthop Trauma. 2015;29(9):428–435.
  31. Lemburg SP, Lilienthal E, Heyer CM. Growth plate fractures of the distal tibia: is CT imaging necessary?. Arch Orthop Trauma Surg. 2010:130(11):1411–1417.
  32. Linsenmaier U, Brunner U, Schöning A, et al. Classification of calcaneal fractures by spiral computed tomography: implications for surgical treatment. European radiology, 2003:13(10):2315–2322.
  33. Badillo K, Pacheco JA, Padua SO, Gomez AA, Colon E, Vidal JA. Multidetector CT evaluation of calcaneal fractures. Radiographics. 2011;31(1):81–92.
  34. Vosoughi AR, Hoveidaei AH, Roozbehi Z, Heydari Divkolaei SM, Zare S, Borazjani R. Patterns of Ankle Fractures Based on Radiographs and CT Images of 1000 Consecutive Patients. Arch Bone Jt Surg. 2024;12(2): 128–135.
  35. Szymański T, Zdanowicz U. Comparison of routine computed tomography and plain X-ray imaging for malleolar fractures-How much do we miss?. Foot Ankle Surg. 2022;28(2):263-268.
  36. Yeung TW, Chan CY, Chan WC, Yeung YN, Yuen MK. Can pre-operative axial CT imaging predict syndesmosis instability in patients sustaining ankle fractures? Seven years' experience in a tertiary trauma center. Skeletal Radiol. 2015;44(6):823-829.
  37. Sowman B, Radic R, Kuster M, Yates P, Breidiel B, Karamfilef S. Distal tibiofibular radiological overlap: Does it always exist?. Bone Joint Res. 2012;1(2): 20–24.
  38. Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int.1997;18(11):693–698.
  39. Dikos GD, Heisler J, Choplin RH, Weber, TG. (2012). Normal tibiofibular relationships at the syndesmosis on axial CT imaging. Journal of orthopaedic trauma, 2012;26(7): 433–438.
  40. Valkering KP, Vergroesen DA, Nolte PA. Isolated syndesmosis ankle injury. Orthopedics, 2012;35(12):e1705–e1710.
  41. Letts R. M. The hidden adolescent ankle fracture. J Pediatr Orthop. 1982;2(2):161–164.
  42. Barg A, Pagenstert GI, Hügle T, et al. Ankle osteoarthritis: etiology, diagnostics, and classification. Foot Ankle Clin. 2013;18(3):411–426.
  43. Cheng YM, Huang PJ, Hung SH, Chen TB, Lin SY. The surgical treatment for degenerative disease of the ankle. Int Orthop. 2000;24(1): 36–39.
  44. Lloyd J, Elsayed S, Hariharan K, Tanaka H. Revisiting the concept of talar shift in ankle fractures. Foot Ankle Int. 2006;27(10):793–796.
  45. Switaj PJ, Mendoza M, Kadakia AR. Acute and Chronic Injuries to the Syndesmosis. Clin Sports Med. 2015;34(4):643–677.
  46. Elgohary MMI, Abdul Rahim SAA, Ibrahim TAA. Role of MRI in evaluation of traumatic ankle injuries. Egypt J Hosp Med. 2017;69(3):2016-24.