Postoperative monitoring of distal intraarticular radial fractures treated with osteosynthesis by means of multislice CT

Purpose: This study evaluates multislice CT (MSCT) for the postsurgical control of intraarticular fractures of the distal radius. Materials and Methods: In 131 patients conventional X-rays in two planes and MSCT were performed. In a consensus process two experienced radiologists judged conventional X-ray and computed tomography images in a random view. The correct position of the osteosynthetic material was assessed and it was ascertained whether an articular surface incongruity, a gap between two fracture fragments, or an intraarticular bone element was detectable. For each point of evaluation a confidence level of the evaluation was assessed on a five-point scale. Results: Ninety patients were classified as having correct alignment and osteosynthesis according to conventional X-ray, while when using the findings from axial CT scans only, 82 patients, and after the addition of multiplanar re-constructions (MPR) only 73 patients were found to have almost proper alignment and osteosynthesis. In 42 patients dehiscence of the fragments was diagnosed with MSCT, but was not visualized by X-ray, leading to surgical revision in eight patients, confirming the diagnosis. In five patients an intraarticular position of intraarticular material was confirmed with MSCT and surgical revision. A significant advantage for the evaluation confidence level was achieved for MPRs in comparison with axial CT scans and X-ray. Conclusion: The marked diagnostic advantage with a high evaluation confidence level in comparison with conventional X-ray methods justify the use of MSCT during postoperative monitoring of articular radial fractures treated with osteosynthesis. (orig.)