OTA 2006 Posters
Scientific Poster #47 Foot and Ankle
Does the Addition of Angiography to CT (CT Angiography) Provide Useful
Information to the Surgeon Planning Surgery on AO/OTA C2 and C3 Tibial Pilon
Fractures?
Cory Collinge, MD1 (*); Alexander Guyott, BS2
(*);
Stuart Aronson, MD3 (*);
1Harris Methodist Hospital-Fort Worth, John Peter Smith Orthopedic
Surgery Residency, Fort Worth, Texas, USA;
2Orthopedic Specialty Associates, Fort Worth, Texas, USA;
3Department of Radiology, Harris Methodist Hospital-Fort Worth,
Fort Worth, Texas, USA
Purpose: Computed tomography (CT) is very useful in the preoperative
planning of pilon fractures. Angiographic data is now available using CT
technology with the addition of intravenous contrast (CTA). To assess the
vascularity in the area of injury of high-energy pilon fractures (OTA C2
and C3 injuries), the authors have used CTA for preoperative planning. The
purpose of this study is to assess the findings of CTA in these injuries
to determine if additional information useful to the surgeon planning reconstructive
surgery is provided by CTA.
Methods: 21 patients with OTA type C2 and C3 pilon fractures were
evaluated with CTA prior to surgical treatment. A protocol of early temporizing
external fixation and CTA was used for all patients. CTA was typically performed
1-2 days after injury. The charted radiologist's reading was used to define
an abnormal CTA. CTA abnormalities were categorized to further define the
pattern of vascular lesion present.
Results: The average age of patients was 43 years (range, 14-74 years).
CTA was found to be abnormal in 9 of 21 (43%) cases. Seven studies showed
acute changes and 2 showed significant chronic (atherosclerotic) changes.
CTA showed acute vascular changes in 4 studies where there was no flow through
a segment of the anterior tibial artery (at the level of the injury), 1
study where there was diminished flow from impingement of fracture fragments
on the anterior tibial artery, and 2 studies in which there was contact
between the fracture fragments and the anterior tibial artery changing the
direction of the vessel, but flow was maintained. No patients had dye reactions
or other problems relating to IV contrast. Patients with CTA-diagnosed vascular
deficit were treated with a variety of open and minimally invasive techniques.
Of the 9 patients with CTA abnormalities, only one patient (who had atherosclerosis
and no acute injury treated with minimally invasive plating) had wound problems
or infection.
Discussion/Significance: A large number (43%) of OTA type C2 and
C3 tibial pilon fractures were found to have alterations in the arterial
system of the leg as assessed by CTA. The anterior tibial artery appeared
particularly at risk for traumatic injury (6 of 7 abnormalities), and was
completely compromised at the level of the injury in 19% of all patients.
CTA appears to be a safe and potentially very useful tool for the evaluation
and preoperative planning of severe injuries of the tibial pilon. More information
as to how CTA may alter treatment is necessary.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.