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Pre-op CT Scan For Distal Radius Fracture: Is It Really Necessary?
Jonathan Guevara, MD; Panattoni Joao, MD
Saint Louis University, Saint Louis, MO

Introduction: Operative treatment of distal radius fractures has gained popularity due to its good outcomes. While preoperative CT scanning theoretically helps preoperative planning, routine use is not standard practice and depends on the surgeon’s preference. The purpose of this study was toevaluate the value of a preoperative CT scan, as determined by postoperative radiographic outcome in patients with a fracture of the distal radius.
Materials/Methods: Between May 2013 and December 2014 62 patients with 66 AO/OTA type 23-C fractures were treated with a volar locking plate and had a postoperative CT scan. All patients were available for review. Postoperative radiographic outcome of these fractures was assessed using the postoperative CT scan, evaluating the following radiographic determinants: radial inclination, volar tilt, step-off, intra-articular gap, and assessment of sigmoid notch reduction. Of these 66 fractures, 32 had a preoperative CT scan, and 34 did not. In this way, radiographic outcome for fractures in which a preoperative CT scan had been obtained for operative planning purposes was compared to that of fractures not scanned preoperatively.
Results: There was no significant difference between the two groups for any of the radiographic outcome determinants. Those without a preoperative CT scan had acceptable radial inclination (19.7 +/- 4.7mm), volar tilt (10.3 +/- 6.4mm), step-off (0.7 +/- 1.2mm), intra-articular gap (1.7 +/- 2.4mm), and sigmoid notch malreduction (3 of 34 not reduced). In comparison, the fractures having a preoperative CT scan had a radial inclination of 17.1 +/- 6.2mm (p = 0.058), a volar tilt of 10.4 +/- 5.4mm (p = 0.913), a step-off of 1.18 +/- 1.2mm (p = 0.115), an intra-articular gap of 2.1 +/- 1.9mm (p = 0.359), and a sigmoid notch malreduction in 1 of 32 the fractures (?2= 0.286)
Conclusions: The plain radiographic appearance of fractures of the distal radius often appears complex, possibly directing the treating surgeon to obtain more advanced – and costly – studies, such as a preoperative CT scan. However, our findings indicate that for the AO/OTA type 23-C fracture treated with a volar locking plate, a preoperative CT scan provides no added value.


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