Mohammadreza Abbasian - Department of Orthopedic Surgery, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran- Center for Advanced Orthopedic Studies, BIDMC, Harvard Medical School, Boston, MA, USA
Farsad Biglari - Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mehrdad Sadighi - Department of Orthopedics ,Shohada Tajrish Hospital ,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran ,Iran
Adel Ebrahimpour - Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Background: The accuracy of reduction of ankle fractures using postoperative plain radiographies (x-ray) remainswidely controversial. Some authors have demonstrated that postoperative computed tomography (CT) scan can beuseful for these patients. In current study, the efficacy of x-rays after fixation of ankle fractures was investigated basedon the CT scan findings.Methods: A total of 73 patients with ankle fractures who were subjected to open reduction internal fixation (ORIF) wereenrolled. After surgery, if the reduction was acceptable based on the x-rays according to standard measurements, thepatient was referred for CT scanning. Forty four patients were included in the study. Undesirable CT scan findingsincluding malreduction of fragments or articular surfaces, device malpositioning, missed fractures, and undetectedintra-articular fragments were documented.Results: Undesirable CT findings were seen in 25 patients (56.8%). CT scan showed acceptable reduction withoutdevice malpositioning in 19 patients. The most prevalent findings in CT images were malreduction and devicemalpositioning in 17 and 16 patients, respectively. There was no abnormal finding in CT imaging of lateral malleolarfractures. In two thirds of the injured syndesmosis, device malpositioning, and malreduction were detected in CT scan.Conclusion: Despite acceptable postoperative x-rays, a considerable number of patients with ankle fractures hadinappropriate reduction or undesirable findings in their postoperative CT scan. It seems necessary to use CT scan afterORIF of ankle fractures in order to examine the accuracy of reduction. Further validation of postoperative CT scan inankle fracture surgery should be investigated.Level of evidence: IV

Ankle fracture, Computed Tomography, Device malpositioning, Malreduction, Plain radiography, Syndesmosis