Evaluation and Classification of Tibial Plateau Fractures Using Spiral Ct and 3D Reformation and Comparison with Plain Radiography

• Main Author: K. Thomas, Nissy
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2019
• Subjects: Age groups; Aging; Arthritis; Bones; Clinical medicine; Closed reduction; Energy; Fractures; Gerontology; Injuries; Ligaments; Medical imaging; Medical personnel; Medicine; Older people; Orthopedics; Osteoarthritis; Patients; Planning; Radiation; Radiography; Surgeons; Surgery; Tomography; Traffic accidents & safety; Transportation; Trauma; Vehicles
• ISBN: 9798380273428

BACKGROUNDFractures of the tibial plateau are among the most challenging fractures in orthopedics to treat. To prevent posttraumatic osteoarthritis and to restore optimal joint function, the congruency of the articular surface, the stability, and the correct load distribution needs to be restored. To achieve this goal, an accurate preoperative planning is essential. Timely identification of the patterns of fractures, extent of displacement and depression of the tibial plateau region are essential for the correction of anatomical distortion and optimal reconstruction of the knee joint. The present study evaluates the role of spiral Computed Tomography and 3D reformation in evaluation and classification of tibial plateau fractures and comparison with plain radiography.OBJECTIVES OF THE STUDY1. To evaluate tibial plateau fractures on CT in axial sections, coronal and sagittal reformations and comparison with 3D reformation.2. To compare the fracture detection rate of CT over plain radiography.3. To classify tibial plateau fractures using Schatzker’s classification.MATERIALS AND METHODSThe study is a hospital based prospective study conducted in the Department of Radiodiagnosis in M. S. Ramaiah Hospitals, Bangalore. The source of data for the study were patients who underwent CT and plain radiography of the knee and found to have tibial plateau fractures. 53 patients with tibial plateau fractures during a period of 20 months from November 2016 to June 2018 were subjected to the study. All patients underwent plain radiography and Computed Tomographic examination of the knee in axial plane followed by multiplanar reformations and 3D reconstruction, and the findings were recorded and statistically analyzed .RESULTSThere were 40 males and 13 females included in the study, their age ranging from 18 to 75 years. The mean age of participants was 34.78 years. Highest number of participants (26.4%) belonged to age group of 40 to 50 and 50 to 60 years. The most common mode of injury was road traffic accidents (92.5%) followed by injury by fall (7.5%).MDCT is the imaging modality of choice to display the presence of fracture, depression of plateau, communition of fragments, the displacement and the extent. In our study the majority of fracture was type VI. The utility of axial, coronal, sagittal and 3D CT images are complementary to each other in the assessment of tibial plateau fractures. And in an overall perspective, CT was found be better as compared to plain radiography in the assessment of presence of fracture, depression, displacement communition and extent of fractures.CONCLUSIONAmong knee fractures tibial plateau fractures are more common. Even though Radiography can detect fractures around 88% of cases, it cannot detect subtle fractures( because of patient position in acute trauma) and depression of fracture fragments ,displacement of fragments , intra articular fragments; which helps in pre-operative planning. These can be accurately evaluated by 3 dimensional CT scan. MDCT is a fast and accurate examination and is recommended in patients with complex knee injuries in order to evaluate the fractures adequately.