![]() ![]() Trail registration numberĬoncomitant fractures of the posterior malleolus (PM) typically occur in distal tibia fractures (Arbeitsgemeinschaft für Osteosynthesefragen Classification AO:43A) and especially in spiral fractures of the tibial shaft (AO:42/43A) with a fracture line extending from proximal-lateral to distal-medial in the anterior–posterior (AP) view (type A). While experiencing improved accuracy, CT imaging should be included in a comprehensive examination of tibial shaft spiral fractures. ![]() Only 17% of PM fractures were identified on plain X-ray and awareness of PM only improved diagnosis by 39%. Inter-rater reliability showed fair agreement (Fleiss-Kappa 0.274, p < 0.001) across all examiners and moderate agreement (Fleiss-Kappa 0.561, p < 0.001) in group 2. The inner-rater reliability was high with 91.2% agreement. No significant differences were demonstrated between radiologists and trauma surgeons. Senior physicians recognized slightly more fractures than residents (residents: 13.0 ± 7.79 senior physicians: 16.5 ± 3.70 p = 0.040). However, there were significantly more false positives in the awareness group (2.5 vs. Significantly more fractures were diagnosed/detected (14 vs. With this in mind, 14.8 ± 5.95 posterior malleolus fractures were detected. If the posterior malleolus fracture was named or a CT was requested, the fracture was considered “detected”. Overall, 9.13/25 (SD ± 5.77) PM fractures were diagnosed on X-ray. One group was primed with the incidence of PM fractures and asked to explicitly assess the PM. Each group was tasked to make a diagnosis and/or suggest if further imaging was needed. Methodsĥ0 X-rays showing 42A/B/C and 43A fractures were evaluated by two groups of physicians, each group was comprised of a resident and a fellowship-trained traumatologist or radiologist. This study investigated the hypothesis that plain X-ray is not sufficient for a reliable diagnosis of associated non-displaced PM fractures in tibial shaft spiral fractures. Tibial shaft spiral fractures and fractures of the distal third of the tibia (AO:42A/B/C and 43A) frequently occur with non-displaced posterior malleolus fractures (PM). ![]()
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