Comparison of radiography and computed tomography in emergency department evaluation of ankle trauma

Abstract

Aim: The aim of this study was to compare computed tomography (CT) and radiography (XR) images of patients presented to theemergency department with ankle trauma and undergone CT imaging, and to describe the fractures for which XR is insufficient andthe characteristics of these fractures.Material and Methods: This retrospectively designed study included patients presented to the emergency department with ankletrauma between January 2016 and December 2017. Patients who had ankle trauma, who performed XR and CT imaging wereincluded in the study. The XR and CT images were reinterpreted by a radiologist.Results: Three hundred and sixteen patients were enrolled in the study. Of the patients, 137 (43.4%) had fracture on XR and 168(53.2%) had fracture on CT. The most common bone fractures were detected lateral malleolus and distal tibia fractures. Thesensitivity and specificity of XR in detecting fracture compared to CT were 75% and 93%, respectively. Sixty-three (20%) of thepatients had two simultaneous fractures. The sensitivity and specificity of XR in detecting two simultaneous fractures were 56%and 94%, respectively. Twelve (3.8%) of the patients had distal tibial, medial malleolus and lateral malleolus fractures (trimalleolarfracture). The sensitivity and specificity of XR in detecting trimalleolar fracture were 17% and 100%, respectively.Conclusion: XR has a low sensitivity in identifying ankle fractures. The sensitivity is much lower in cases of two simultaneousfractures and trimalleolar fractures. Therefore, CT imaging should be preferred in patients with complex ankle injuries.