Conclusion
fracture, fractures
Concomitant fractures of the posterior malleolus in tibial shaft fractures were not reliably detected in plain X-rays, regardless of physicians’ specialty or level of training. Awareness of the frequency of these additional fractures in tibial shaft spiral fractures with a course from proximal-lateral to distal-medial in the AP X-ray (type A) leads to a significantly higher detection rate, but also to a more frequent misdiagnosis in the absence of a fracture of the posterior malleolus. None of the investigators could reach a satisfactory level of certainty in the detection of concomitant posterior malleolus injuries in plain X-rays. Consequently, plain X-ray imaging is not sufficient for the diagnosis of tibial shaft spiral fractures.
