Additional Comments

I wish to add some comments regarding intra-articular fractures.

1. Intra-articular fractures require a clear preoperative investigation by means of computed tomography (CT) scanning.

2. Intraoperative image amplification x-rays can expose only the cortical structures with certainty, but not small dislocations of the subchondral bone plate. For this reason, amplified images cannot be considered as an adequate imaging technique confirming the correct reposition of the articular surface.

3. For this reason it is necessary to reconstruct visually the articular surface intraoperatively–that is, to open the joint.

4. The achieved results of the intra-articular reconstruction will have to be controlled postoperatively by CT; conventional x-ray images are not sufficient, as the articular surfaces are curved.

5. This CT needs to be carried out directly after the operation, so as to be able to correct dislocations in a second operation if required. The CT also helps the surgeon to check themselves and their learning curve. Even senior physicians/consultants should check their performance in this way.

6. Standard x-ray settings are always associated with different angle and rotational positions; for this reason they can expose only small articular segments. Irregular articular surfaces therefore often remain concealed and are detected only on a later CT scan at assessment.

7. Close postoperative radiological controls have to be indicated by the surgeon, depending on the stability of the reconstructed articular surface they managed to achieve.

8. An overall reduction or avoidance of postoperative radiological controls is therefore justified only in safely stabilized extra-articular fractures, but not in intra-articular fractures, where additional information from postoperative CT is crucial for maintaining articular function.