Comparison between standard radiography and spiral CT with 3D reconstruction in the evaluation, classification and management of tibial plateau fractures

Abstract

Background: Proximal tibia is one of the most critical weights bearing part of the human body. Fractures of the plateau affect knee alignment, stability, and motion. The present study was conducted to decide whether pre-operative CT scan significantly changes the line of action and plan of surgery, against simple digital radiographs, in managing fractures of the upper tibial condyles and hence should it be an essential investigation for treatment in proximal tibial fractures. Materials & Methods:The present cross-sectional, prospective study was conducted on 42 cases (males-37, females-5) of traumatic fractures of the proximal tibia. First opinion was taken on the basis of the X-ray alone and second opinion was taken after showing the CT scans. Results: There were 16 (38.09%) patients in age group of < / = 30 years, 17 (40.48%) patients in age group of 30-45 years, 8 (19.05%) patients in age group of 45-60 years and only 1 (2.38%) patient is the age group of 60-75 years. There were 02 (04.76%) patients diagnosed to have no fracture based on X-ray, 14 (33.33%) patients diagnosed as Schatzker's type-1, 02 (04.76%) patients diagnosed as Schatzker's type-2, 05 (11.91%) patients diagnosed as Schatzker's type-4, 13 (30.95%) patients diagnosed as Schatzker's type-5 and 06 (14.29%) patients diagnosed as Schatzker's type-6 based on X-ray alone. A total 12 cases were included in Schatzker's type 1. Management of 01 case was drastically changed, that of 03 cases had subtle changes and that of 08 cases remained unchanged. Plan of 01 case out of 04 included in Schatzker's type 2 was changed drastically, 02 underwent subtle changes while that of 01 was unchanged. Only 01 case was included in Schatzker's type 3. Its management underwent subtle change. 02 cases were diagnosed as type 4. Treatment of 01 underwent subtle change while that of 01 remained unchanged. Plan of 02 cases out of 06 included in type 6 were drastically changed. 04 had no changes. Conclusion: CT scan contributes significantly in management of proximal tibia fractures especially in Schatzker's type 1 and type 4. It reveals articular depressions and fracture fragments that are often obscured on X-rays. It helps surgeons to prevent dreadful postoperative complications.

Comparison of Conventional Radiography and Multidetector Computed Tomography Scan in Knee Trauma in Rajavithi Hospital

“…The study highlighted a decrease in XR sensitivity as the number of fractured bones increased, likely due to anatomical complexities with multiple fractures. Therefore, both MDCT and XR can be used together for better diagnosis, preoperative assessment and management of tibia fractures [13]. Our study supports the combined use of XR and MDCT, demonstrating that utilizing both imaging modalities together significantly improves diagnostic efficacy, especially when compared to XR alone.…”

“…The study emphasized that MDCT scanning should be performed when fracture type and characteristics cannot be accurately determined using XR imaging in knee injuries. Ranjeet et al [13] conducted a comparison between XR and MDCT with 3D reconstruction in the evaluation, classification, and management of tibial plateau fractures. Two patients (4.76%) were initially diagnosed as having no fractures based on plain radiography, but MDCT examination revealed fractures in 100% of the cases and provided more detailed classification of tibial plateau fractures compared to normal radiography.…”

Frequency of Bone Fractures Detected by Plain Radiography and Keeping Ct as Gold Standard

“…CT scan contributes significantly in management of proximal tibia fractures especially in Schatzker's type 1 and type 4. 9 Carpus fractures account for 50% of all fractures in upper extremity. Computed tomography for the diagnosis of these fractures has been shown to be superior to radiographic results.…”