Comparison of treatment options based on X-ray and computed tomography findings in patients presenting to the emergency department with foot and ankle trauma

Aim: This study investigated the differences between direct radiography (X-ray) and computed tomography (CT) in detecting pathological findings in patients presenting to the emergency department with foot and/or ankle trauma and evaluated their role in predicting treatment requirements and modifications. Materials and Methods: The study was conducted at the Emergency Department of Van Yüzüncü Yıl University Faculty of Medicine between January 1, 2017, and December 31, 2019. CT and X-ray results, along with clinical data of patients with foot and/or ankle trauma, were retrospectively analyzed. Results: Imaging revealed pathology only on CT in 8.9% of cases, on both CT and X-ray in 24.9%, while the remaining patients had normal imaging results. The mean Glasgow Coma Scale score was significantly lower in patients with pathology detected on both modalities (p = 0.018). Patients with CT-only findings were more frequently treated with splinting/casting, whereas surgical intervention rates were significantly higher in those with pathology on both imaging modalities (p < 0.001). Furthermore, the need for treatment modification was markedly greater in patients with CT-only pathology compared to other groups (p < 0.001). Conclusion: In the management of foot and ankle trauma in the emergency setting, selecting the appropriate imaging modality plays a critical role in enhancing diagnostic accuracy and guiding proper treatment. Particularly, CT is valuable in detecting injuries missed by X-ray, not only informing initial treatment decisions at admission but also providing important predictive value for subsequent treatment modifications.