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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (1): 156-159. doi: 10.19723/j.issn.1671-167X.2023.01.024

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Radiographic diagnosis of distal fibula avulsion fractures: Comparison of ankle X-ray and three-dimensional reconstruction of CT

Shi-kai XIONG,Wei-li SHI,An-hong WANG,Xing XIE,Qin-wei GUO*()   

  1. Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine, Peking University; Beijing Key Laboratory of Joint Injuries in Sports Medicine; Beijing 100191, China
  • Received:2021-06-04 Online:2023-02-18 Published:2023-01-31
  • Contact: Qin-wei GUO E-mail:guoqinwei@vip.sina.com
  • Supported by:
    the National Key Research and Development Program of China(2018YFF0301100);the Clinical Key Project of Peking University Third Hospital(BYSY2018011)

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Abstract:

Objective: To investigate the difference in sensitivity between X-ray and three-dimensional reconstruction of computed tomography (3D-CT) for the diagnosis of distal fibular avulsion fracture, and the radiographic presentation of the ossicle. Methods: From January to October 2018, 92 patients with distal fibular avulsion fracture were visited for surgical treatment in Department of Sports Medicine, Peking University Third Hospital, and 60 cases were finally enrolled according to the inclusion and exclusion criteria. Intraoperative detection was regarded as the gold standard, and the diagnostic sensitivity of preoperative ankle X-ray and 3D-CT for the distal fibular avulsion fractures was statistically determined. The ossicle maximum diameter as well as the degree of its displacement were also measured. On 3D-CT, the distance from the ossicle center point to the anterior fibular tuberosity (a), the distance to the fibular tip (b), and the a/b value was used to present the ossicle displacement. Results: Among the 60 patients, 36 and the 52 patients were correctly detected by X-ray and 3D-CT, respectively, and the sensitivities was 60.0% and 86.7%, respectively (P=0.004). The mean diameter of the ossicle on X-ray and 3D-CT was (9.2±3.9) mm and (10.5±3.2) mm, respectively. The mean distance from the ossicle center to the anterior fibular tuberosity (a) was (17.5±3.6) mm and the mean distance to the fibular tip (b) was (17.4±4.8) mm, with mean a/b values of 1.1±0.7. The intraclass correlation coefficients (ICC) for each measurement ranged from 0.891-0.998 with a high degree of consistency. Conclusion: Compared with X-ray, 3D-CT has higher sensitivity in diagnosing distal fibular avulsion fractures, can help clinicians evaluate ossicle's location and choose surgical methods, and is recommended to be performed in patients with suspected distal fibula avulsion fractures in clinical practice.

Key words: Ankle joint, Avulsion fracture, Lateral ankle ligament, Imaging, three-dimensional

CLC Number: 

  • R683.42

Figure 1

The ossicle of distal fibula avulsion fractures (white arrow) and its diameter (white line)"

Figure 2

The bone fracture diameter (white line), the distance from the bone fracture to the fibular anterior tubercle (a, blue line) and to the fibular tip (b, orange line) in the 3D-CT A and B, preoperative 3D-CT images of the right ankle of a patients with an old avulsion fracture ossicle near the distal fibula. 3D-CT, three dimensional reconstruction of computed tomography."

Table 1

Demographic data of 60 patients with distal fibular avulsion fracture"

Parameter Data
Age/years, $\bar x \pm s$ 27.9±11.2
Gender, n (%)
  Male 27 (45.0)
  Female 33 (55.0)
Side, n (%)
  Left 27 (45.0)
  Right 33 (55.0)
BMI, $\bar x \pm s$ 23.8±4.3
Duration time/month, $\bar x \pm s$ 25.2±46.2

Table 2

Diameter and displacement degree of the ossicle measured by two observers"

Parameter Ossicle, $\bar x \pm s$ ICC value
X-ray diameter/mm, n=36 9.2±3.9 0.987
3D-CT diameter/mm, n=52 10.5±3.2 0.891
a value/mm, n=52 17.5±3.6 0.995
b value/mm, n=52 17.4±4.8 0.979
a/b value, n=52 1.1±0.7 0.998
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