Weight-Bearing CT Scan After Tibial Pilon Fracture Demonstrates Significant Early Joint-Space Narrowing.

Journal Article (Journal Article)

BACKGROUND: Posttraumatic osteoarthritis (PTOA) is a common and early sequela of tibial pilon fractures resulting in substantial long-term disability. New approaches are needed to objectively and reliably quantify early disease progression in order to critically assess the impact of interventions aimed at preventing or mitigating PTOA. Weight-bearing computed tomography (WBCT) scans provide a means for measuring joint space while the ankle is in a loaded, functional position. We assessed the interrater and intrarater reliability of a standardized, regional method to quantify joint-space loss following tibial pilon fracture compared with the uninjured contralateral ankle. METHODS: We prospectively enrolled 20 patients with intra-articular tibial pilon fractures that were surgically treated at 1 of 2 level-I trauma centers. Six months after injury, bilateral ankle WBCT scans were obtained. Joint space was measured by 4 reviewers at 9 discrete regions of the tibiotalar articulation on sagittal images. Measurements were repeated by reviewers 2 weeks later. To characterize the measurement method, interrater correlation coefficient estimates and test-retest reproducibility were calculated. RESULTS: The mean tibiotalar joint space was 21% less in the injured ankles compared with the contralateral uninjured ankles (p < 0.0001). The middle-lateral and middle-central regions of the joint demonstrated the greatest decrease in joint space between injured and uninured ankles. The interrater correlation coefficient of the measurement technique was 0.88, and the test-retest reproducibility was 0.80, indicating good reliability and reproducibility of the method. CONCLUSIONS: We developed a simple, standardized, and reliable technique to quantify tibiotalar joint space following tibial pilon fracture on WBCT. Significant loss of joint space is seen 6 months after the injury. This tool can be used to longitudinally quantify loss of joint space following pilon fracture and assess the impact of interventions to reduce PTOA.

Full Text

Duke Authors

Cited Authors

  • Willey, MC; Compton, JT; Marsh, JL; Kleweno, CP; Agel, J; Scott, EJ; Bui, G; Davison, J; Anderson, DD

Published Date

  • May 6, 2020

Published In

Volume / Issue

  • 102 / 9

Start / End Page

  • 796 - 803

PubMed ID

  • 32379120

Electronic International Standard Serial Number (EISSN)

  • 1535-1386

Digital Object Identifier (DOI)

  • 10.2106/JBJS.19.00816


  • eng

Conference Location

  • United States