Utility of double-contrast multidetector CT scans to assess cartilage thickness after tibial plafond fracture

Abstract

Thaddeus P Thomas1,2, Christopher J Van Hofwegen1, Donald D Anderson1,2, Thomas D Brown1,2, J Lawrence Marsh11Department of Orthopedics and Rehabilitation, 2Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USAAbstract: The pathophysiology of posttraumatic osteoarthritis (PTOA) after intraarticular fractures is poorly understood. Pursuit of a better understanding of this disease is complicated by inability to accurately monitor its onset, progression and severity. Common radiographic methods used to assess PTOA do not provide sufficient image quality for precise cartilage measurements. Double-contrast multidetector computed tomography (MDCT) is an alternative method that may be useful, since it produces high-quality images in normal ankles. The purpose of this study was to assess this technique’s performance in assessing cartilage maintenance in ankles with an intraarticular fracture. Thirty-six tibial plafond fractures were followed over two years, with 31 MDCTs being obtained four months after injury, and 22 MDCTs after two years. Unfortunately, clinical results with this technique were unreliable due to pathology (presumed arthrofibrosis) and technical problems (pooling of contrast). The arthrofibrosis that developed in many patients inhibited proper joint access and contrast infiltration, although high-quality images were obtained in 11 patients. In this patient subset, in which focal regions of cartilage degeneration could be visualized, thickness could be measured with a high degree of fidelity. While thus useful in selected instances, double-contrast MDCT was too unreliable to be recommended to assess these particular types of injuries.Keywords: posttraumatic osteoarthritis, cartilage, imaging, fracture