胫骨后外侧平台骨折的CT形态学研究

 目的 探讨胫骨后外侧平台关节面骨折在胫骨平台骨折中的发生率及其形态学特点。方法 回顾性分析2008年 5月至 2013年 1月 309例胫骨平台骨折患者的 CT图像及临床资料,其中 45例 CT图像缺失或不兼容医学影像存储和传输（PACS）系统予排除,共纳入 264 例患者资料。确定胫骨平台后外侧象限关节面骨折块在胫骨平台骨折中的发生率并测量其骨折线的轴向角度、受累面积、矢状位角度、骨折块高度及移位程度等形态学参数。结果 在 264例胫骨平台骨折中,共检测到 39例胫骨平台骨折存在后外侧象限关节面骨折块,在胫骨平台骨折中的发生率为 14.8%（39/264）。其中男 18例,女 21例;年龄 31~70岁,平均 52岁;左侧 17例,右侧 22例。致伤原因：交通伤 22例,重物砸伤 2例,摔伤 11例,受伤原因不明 4例。后外侧象限关节面骨折块的骨折线偏于冠状位,骨折线轴向角度为-43°~62°,平均 22°;受累的后外侧骨折块面积占整个胫骨平台面积的 8%~32%,平均 14.1%;后外侧平台骨折块的矢状位角度为 58°~97°,平均 76°,提示该骨折块在垂直剪切应力下易发生移位;后外侧骨折块的高度为 18~42 mm,平均 28 mm;后外侧髁骨折块平均移位 2~19 mm,平均 10.48 mm。结论 胫骨平台骨折累及后外侧平台关节面的发生率为 14.8%;胫骨后外侧平台关节面的骨折线偏于冠状位且矢状位角度较大,骨折块所累及的关节面面积较小。     

CT在胫骨平台后柱骨折诊断中的应用

目的 探讨CT及三维重建影像在胫骨平台骨折诊断和治疗中的价值. 方法 2004年7月至2007年7月202例胫骨平台骨折患者均行X线片、CT平扫及三维重建影像学检查,根据CT图像将胫骨平台划分为三个区域(三柱),并据此分型,统计胫骨平台后柱骨折的发病率,并将结果与X线片分型(Schatzker分型)及术中所见对比,分析CT及三维重建影像在胫骨平台骨折诊断和分型中的作用. 结果 202例胫骨平台骨折患者中有21例X线片诊断结果与CT不符:其中5例无法确定诊断,16例分型错误.202例经CT或三维重建均获诊断分型.CT发现后柱骨折的患者为47例(23.2%),均与术中诊断符合.X线与CT分型符合率为89.6%,主要原因为X线片很难发现后柱平台骨折. 结论CT三维重建影像能直观、立体地显示胫骨平台骨折的形态,有助于胫骨平台骨折的正确分型.胫骨平台后柱骨折并不罕见,CT检查可以明确诊断,三柱分型能帮助我们提出更有针对性的治疗方案.     

三钢板固定治疗复杂胫骨平台双髁四象限骨折的疗效分析

[目的]探讨通过联合入路用三钢板治疗复杂胫骨平台双髁四象限骨折的疗效。[方法]选取2010年1月~2013年2月本院收治的复杂胫骨平台双髁四象限骨折患者28例。根据Schatzker分型均为Ⅵ型,AO/OTA分型为41C2、C3型。男23例,女5例,年龄21~63岁,平均42.6岁。摆仰卧漂浮体位用三块钢板坚强固定,以"钉-筏"形式支撑关节面防止二次塌陷,取自体髂骨或人工骨填充植骨,术后应用影像学及Rasmussen膝关节量表进行功能评价。[结果]28例均获得随访,随访时间24~36个月,平均28.5个月。术后骨折均临床愈合,断端无移位,内固定物无松动、断裂、失效等并发症发生,无关节面塌陷,关节功能基本恢复正常。术后膝关节Rasmussen量表评价,优19例,良6例,可2例,差1例,优良率为89.3%。术后即刻胫骨平台内翻角(TPA)及胫骨平台后倾角(PA)度数与术后1年比较,组间差异无统计学意义(P0.05)。[结论]应用三钢板内固定治疗累及双髁四象限的复杂胫骨平台骨折,具备能解剖复位、牢靠固定及早期膝关节功能锻炼等优点,是一种有效、安全的方法。     

改良后内侧倒L形入路在胫骨平台后柱骨折手术中的应用

目的探讨经膝关节后侧改良倒L形入路手术治疗胫骨平台后柱骨折的效果。方法自2014-03—2015-03诊治因外伤致胫骨平台后柱骨折15例,骨折按Schatzker分型:Ⅱ型4例,Ⅴ型8例,Ⅵ型3例,按照三柱分型均为三柱损伤。采用改良倒L形入路直视下复位后外侧关节面,植骨排钉固定后外侧粉碎塌陷关节面。结果本组均获随访平均12.1(8~13)个月,术后均恢复下肢力线和关节面高度。骨折愈合时间平均为7.6(6~9)个月,无神经血管损伤、内固定失效、关节僵硬和骨性关节炎等并发症发生。术后6个月膝关节屈伸活动度为5°~130°,膝关节HSS评分平均92.1(72~91)分。结论对于后外侧胫骨平台骨折关节面粉碎伴塌陷的患者,采用改良入路能直视复位关节面和植骨放置排钉钢板,达到对骨折完美支撑。     

螺旋CT三维重建对胫骨后侧平台骨折诊治作用

目的探讨螺旋CT三维重建对胫骨后侧平台骨折的诊治指导作用,为临床诊治提供更有效的检查手段。方法选择2015年1月至2018年12月医院收治的92例胫骨后侧平台骨折患者,对92例患者分别采用X线摄片和螺旋CT三维重建检查进行诊断,将手术结果与检查诊断结果进行对比,比较两种检查方式的检出率、诊断正确率及分型符合率,关节面塌陷和交叉韧带、半月板、侧副韧带等软性结构损伤的诊断情况。结果 CT三维重建检查诊断胫骨后侧平台骨折检出率、诊断正确率均高于X线检测,X线检查漏诊率、可疑率均高于CT三维重建检查,两种检测方式差异有统计学意义(P0.05);CT三维重建分型符合率显著高于X线,CT三维重建诊断关节面塌陷率、软性结构损伤率显著高于X线,两组差异有统计学意义(P0.05)。结论螺旋CT三维重建可立体直观的显示出胫骨后侧平台骨折的形态,准确提供了骨折分型,提高了诊断的准确率,为胫骨后侧平台骨折的诊治提供了指导作用。     

QCT辅助评价胫骨平台骨折形态的临床分析与应用研究

目的 通过地图投影技术及定量CT(Quantitative computed tomography,QCT)影像技术评估胫骨平台五柱分型下骨折形态、骨密度在临床诊疗上的价值。方法 收集自2018-08—2022-07诊治的68例胫骨平台骨折的三维CT影像数据,应用Mimics 20.0软件重建健侧胫骨平台标准3D模型,对患侧骨折区域进行三维重建、复位,将复位的三维骨折模型导入3-matic软件中,在标准模型上识别骨折区域并叠加,应用MATLAB软件进行三维热图可视化处理。按照胫骨平台五柱分型,观察胫骨平台骨折区域三维图形在二维平面下各柱形态变化及骨折发生率,同时在健侧胫骨平台内外侧标记感兴趣区域,应用QCT准确获取骨密度值,对比内外侧柱骨密度值与骨折形态的相关影响。结果 胫骨平台骨折三维重建结果显示胫骨平台前内侧柱骨折19例,占比27.94%;胫骨平台前侧柱（结节区域）骨折30例,占比44.11%;胫骨平台前外侧柱骨折53例,占比77.94%;胫骨平台后外侧柱骨折42例,占比61.76%;胫骨平台后内侧柱骨折24例,占比35.29%。骨折热图结果及分布比例显示前外侧柱及后外侧柱骨折分布...     

应用CT三维重建和关节镜监视下治疗胫骨平台骨折

目的:探讨应用CT三维重建和关节镜监视下治疗胫骨平台骨折中的价值。方法:收集22例胫骨平台骨折病例,术前常规进行X线摄片,按Schatzker分类:Ⅰ型4例,Ⅱ型5例,Ⅲ型2例,Ⅳ型6例,Ⅴ型3例,Ⅵ型2例。然后对骨折在3D重建图像后再分型:前外象限4例,后外象限8例,前内象限4例,后内象限2例,涉及内和外象限4例。在关节镜监视下结合3D重建对骨折进行复位和内固定。结果:22例胫骨平台骨折3D重建图像分型与关节镜术中的诊断一致。平台骨折需要植骨15例。松质骨螺钉固定4例,单侧支撑钢板内固定8例,双侧支撑钢板内固定4例,单侧支撑钢板加松质骨螺钉固定6例。随访3个月~2年,根据HSS膝关节评分标准:优18例,良2例,可2例。结论:螺旋CT及3D重建补充了在胫骨平台三维空间上新的骨折分型,对手术入路、复位和内固定有指导意义。关节镜监视下有助于骨折复位,对骨折块的血运干扰少,骨折愈合快。     

胫骨平台内外侧前髁冠状位劈裂骨折的临床分析

目的 探讨胫骨平台内外侧前髁冠状位劈裂骨折的损伤机制、分型及手术方法.方法 收治胫骨平台内外侧前髁冠状位劈裂骨折7例,手术采用垂直双钢板技术进行固定;并对损伤原因、影像学表现进行回顾性分析.结果 本组1例因胭血管损伤导致截肢,其余6例骨折复位评估:4例获得满意的关节面复位;5例获得满意冠状面力线;5例获得满意的矢状位力线;6例双髁复位增宽在25 mm.MFA问卷评分平均27.37分(2～59分).结论 胫骨平台内外侧前髁冠状位劈裂骨折采用垂直双钢板技术治疗可取得满意疗效:但其形态学定义、分类归属、手术径路的解剖学基础、内固定植入物的研制及复位固定的生物力学研究还有待进一步深入研究.     

胫骨平台骨折三柱分型的可信度评价

 目的 研究胫骨平台骨折三柱分型不同观察者间的可信度,并与传统Schatzker分型进行比较,证实三柱分型的可靠性。方法 2004年12月至2007年3月,对胫骨平台骨折患者进行三柱分型,根据分型选择手术切口和治疗。采用随机数表法从304例（323膝）胫骨平台骨折中抽取50例,选择4位未参与该项手术的工作人员,在规定时间内完成对每例胫骨平台骨折的三柱分型和Schatzker分型的评估。评估结束后使用Kappa值计算4组相关度,以比较评价三柱分型和Schatzker分型的可信度差别。结果 323膝胫骨平台骨折中,0柱骨折4膝（1.2%）,单柱骨折181膝（56.0%）,双柱骨折108膝（33.4%）,三柱骨折30膝（9.3%）。在单柱骨折中,外侧柱114膝（63.0%）,内侧柱53膝（29.3%）,后侧柱14膝（7.7%）。在双柱骨折中,外侧柱合并内侧柱36膝（33.3%）,内侧柱合并后侧柱34膝（31.5%）,外侧柱合并后侧柱38膝（35.2%）。三柱分型的可信度Kappa值为0.766（0.706～0.890),属于基本可信程度;Schatzker分型的可信度Kappa值为0.567（0.513～0.589）,属于中度可信程度。结论 基于CT和三维重建的胫骨平台骨折三柱分型直观明了,具有较高可信度,建议作为新的分型系统在临床推广和应用。     

三维CT重建在累及关节面的复杂骨折治疗中的指导意义

目的　探讨三维CT重建在累及关节面的复杂骨折治疗中的指导意义。方法　自 1997年至今 ,我科共收治累及关节面的复杂骨折 35例 (包括髋臼骨折 4例、胫骨平台骨折 2 0例、距下关节骨折 11例 ) ,术前均行X线摄片并行CT扫描和三维CT重建 ,对关节面损伤程度进行评估并制定最佳治疗方案。结果　 4例髋臼骨折中 3例行手术治疗 ,2 0例胫骨平台骨折中 15例行手术治疗 (12例行植骨 ) ,11例距下关节骨折 7例行手术治疗。结论　三维CT重建能清楚地显示传统X线摄片所不能直接显示的关节面骨折 ,对手术前的骨折分类、治疗方案制订以及手术入路选择有一定的指导意义     

三维CT成像对胫骨平台骨折术前评价结果的信度与效度分析

目的 通过比较使用三维CT与二维CT影像时对胫骨平台骨折分型和骨折特征术前评定结果 的信度与效度,探讨三维CT的诊断优势.方法 4名骨科高年资医生回顾性分析2004年9月至2006年11月间收治的21例胫骨平台骨折患者的病历,分别使用二维CT和三维CT影像对骨折分型和骨折特征做出判断,使用一致性检验来分析骨折分型判断结果 的评定者间信度和评定者自身信度,和对骨折特征判断结果 的标准效度(术中观察结果 作为金标准),并用McNemar检验比较三维CT和二维CT判断结果 与金标准的一致性差异.结果 使用三维CT时,对骨折分型判断结果 的评定者间信度和评定者自身信度均改善为极度一致,对骨折特征判断结果 与金标准的一致性显著性高于二维CT(P=0.027).结论 使用三维CT影像能提高对胫骨平台骨折分型和特征术前评价的可靠性和准确性,三维CT对胫骨平台骨折术前评价有很高的应用价值.     

CT三维重建在胫骨平台骨折诊疗中的应用价值

目的探讨三维CT扫描对复杂胫骨平台骨折的分型及治疗方法选择的临床应用价值。方法 2006年4月至2008年3月对36例胫骨平台骨折患者的临床资料进行分析。其中男21例,女15例;平均44.5岁(23～56岁);左侧16例,右侧20例。术前均投照患侧膝关节正、侧位X线片及CT扫描,并进行后期三维重建。按照胫骨平台骨折Schatzker分型方法,对普通X线片与结合CT扫描的两种分型结果进行比较。结果 36例中7例改变原有分型(18.3%),有4例最终依据CT图像分型改变手术入路和内固定方法。36例中经CT证实合并胫骨髁间棘骨折共7例(18.3%),而普通X线检查仅发现较明显移位的4例髁间骨折。结论 CT三维重建对胫骨平台骨折分型及临床治疗方法的选择具有重要指导意义。     

Tibial plateau fractures. A new classification scheme

Fractures of the tibial plateaus are common injuries. Various classification schemes have been used to describe these injuries. Although each system has its own purpose, the simpler systems do not allow comparison with more complex divisions. The problem is compounded by the variable use of adjectives that describe these fractures. A comprehensive classification of tibial plateau fractures should group fractures that are similar in topography, morphology, and pathogenesis, requiring similar treatment, and having a similar prognosis. Fracture dislocations and standard tibial plateau fractures should be incorporated into a single classification to avoid the use of two complementary classifications. Any such classification should not be difficult to remember or to use. Keeping in mind these requirements, the authors devised a simple yet comprehensive classification. The authors studied 80 cases of tibial plateau fractures from January 1988 to September 1997, and used contemporary classifications of tibial plateau fractures as a database to formulate the new classification. A new fracture, subcondylar bicondylar with coronal split, has been classified for the first time. An alphanumeric system has been developed that has made nomenclature easy to remember and use. An effort has been made to address the profoundly confusing issue of variable adjectives that describe these injuries. A review of the literature shows that fractures in the authors' classification have been grouped according to similar pathomechanics, treatment, and functional results.     

Intra-articular tibial plateau fracture characteristics according to the “Ten segment classification”

BackgroundCurrently existing classifications of tibial plateau fractures do not help to guide surgical strategy. Recently, a segment-based mapping of the tibial plateau has been introduced in order to address fractures with a fracture-specific surgical approach. The goal of the present study was to analyze incidence and fracture specifics according to a new 10-segment classification of the tibial plateau.MethodsA total of 242 patients with 246 affected knees were included (124 females, 118 males, mean age 51.9 ± 16.1 years). Fractures were classified according to the OTA/AO classification. Fracture pattern was analyzed with respect to a 10-segment classification based on CT imaging of the proximal tibial plateau 3 cm below the articular surface.Results161 Patients suffered an OTA/AO type 41-B and 85 patients an OTA/AO type 41-C tibial plateau fracture. Females had an almost seven times higher risk to suffer a fracture due to low-energy trauma (OR 6.91, 95% CI (3.52, 13.54), p < 0.001) than males. In 34% of the patients with affection of the medial tibial plateau, a fracture comminution, primarily due to low-energy trauma (p < 0.001), was observed. In type B fractures, the postero-latero-lateral (65.2%), the antero-latero-lateral (64.6%) and the antero-latero-central (60.9%) segment were most frequently affected. Every second type C fracture showed an unique fracture line and zone of comminution. The tibial spine was typically involved (89.4%). A typical fracture pattern of high-energy trauma demonstrated a zone of comminution of the lateral plateau and a split fracture in the medial plateau. The most frequently affected segments were the postero-latero-central (85.9%), postero-central (84.7%), and antero-latero-central (78.8%) segment.ConclusionPosterior segments were the most frequently affected in OTA/AO type B and C fractures. Acknowledging the restricted visibility of posterior segments, whose reduction and fixation is crucial for long-term success, our findings implicate the use of posterior approaches more often in the treatment of tibial plateau fractures. Also, low-energy trauma was identified as an important cause for tibial plateau fractures.     

Proximale Tibiafrakturen

Although newly developed computed tomography (CT)-based classifications for proximal tibial fractures could not exactly depict all fracture types, an individual treatment concept can be deduced from them. The use of these classifications enables a well-structured approach to stabilize most fracture patterns. In own studies it could be demonstrated how important it is to pay attention to coronal and sagittal fracture lines. Therefore, consistent use of reproducible three-dimensional CT-based classifications may lead to a standardized surgical treatment algorithm and may facilitate preoperative planning. Consequently, this may result in reduced operation times and improved clinical results. Unicondylar fractures can be successfully stabilized by the combination of screw and plate osteosynthesis, which in the case of impression fractures of the tibial plateau has to be supplemented by additional defect augmentation. Due to the complexity of bicondylar fractures there is a broad spectrum of options available for osteosynthesis. It is essential to make an accurate analysis of fracture morphology and the stable retention of essential fracture fragments, particularly the dorsal fragments.     

Impact of MRI on treatment plan and fracture classification of tibial plateau fractures

OBJECTIVE: To evaluate the interobserver agreement for both treatment plan and fracture classification of tibial plateau fractures using plain radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). DESIGN: Prospective study to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures among three orthopaedic surgeons. SETTING/PARTICIPANTS: Patients presenting with tibial plateau fractures to a level I trauma center were evaluated with plain knee radiographs (anteroposterior, lateral, two oblique views), CT scan, and MRI. Three experienced attending orthopaedic trauma surgeons were randomly presented three sets of studies for each injury: radiographs alone, radiographs with CT, and radiographs with MRI (including soft tissue injuries documented by an experienced MRI radiologist). The surgeons were asked to render fracture classification and treatment plan based upon the blind reading of each individual radiographic set. MAIN OUTCOME MEASURES: Agreement among the three surgeons was measured using kappa coefficients. RESULTS: For fracture classification, radiographs alone yielded a mean kappa coefficient of 0.68, which increased to 0.73 for radiographs with CT scan and 0.85 for radiographs with MRI. Fracture classification (Schatzker) was changed an average of 6% with the addition of the CT scan and 21% based on radiographs with MRI. For the fracture management plan, the mean interobserver kappa coefficient for radiographs alone was 0.72, which increased to 0.77 for radiographs with CT scan and 0.86 for radiographs with MRI. MRI changed treatment plan in 23% of the cases. CONCLUSION: Magnetic resonance imaging increases the interobserver agreement on fracture classification and operative management of tibial plateau fractures.     

Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures

Objective

The purpose of this study was to determine whether three-dimensional reconstructed computed tomography (CT) images can improve intra-observer and inter-observer reliability for classification systems of tibial plateau fractures compared to plain radiographs and two-dimensional CT images.

Methods

Twenty-one tibial plateau fractures were classified independently by four attending orthopaedic trauma surgeons using the AO/ASIF and Schatzker classification systems. First, a combination of plain radiographs and two-dimensional (2D) CT images were evaluated. Second, 4 weeks later, plain radiographs and three-dimensional (3D) CT images were assessed. Then, 4 weeks later, these two rounds of evaluation were repeated. The intra-observer and inter-observer reliability were assessed using kappa statistics.

Results

Three-dimensional CT images can improve the inter-observer and intra-observer reliability regarding both AO/ASIF and Schatzker classification systems of tibial plateau fractures compared to 2D CT images. The degree of agreement of the inter-observer and intra-observer reliability among four surgeons increased from ‘substantial’ to ‘almost perfect’.

Conclusion

Three-dimensional CT is a more reliable radiographic modality than 2D CT in evaluation of fracture patterns in tibial plateau fractures. This finding seems to show that more sophisticated imaging techniques can improve the reliability of fracture classification systems.     

Two column classification of tibial plateau fractures; description,clinical application and reliability

PurposeIn this era of life highly comminuted and multi planar tibial plateau fractures involving the posterior corners are more commonly seen and addressed in the literature than before. Among these several types have not been described in the currently used classification systems. In fact simple classification systems ignore several fracture types and leniently grouped the fractures with different mechanism, morphology, treatment modalities and prognosis in same category. On the other hand, more extensive nature classifications with detailed subdivisions are difficult to remember for clinicians. The clinical reliability of these classifications is another problem. All these issues demand the potential need of a new classification. The aim of this study was to describe a quadrant specific two column classification of tibial plateau fractures and to analyse its inter-observer and intra-observer reliability, clinical assessment and application.Materials and methodsFrom January 2009 to December 2015, 44 patients with tibial plateau fractures were studied retrospectively. The antero-posterior (AP), lateral X-rays and computed tomography (CT) with axial transverse, sagittal, coronal and three dimensional (3D) reconstruction images were performed for all the patients. All of the fractures were categorized according to quadrant specific two column classification and the traditional Schatzker’s classification. The comparative analysis for inter-observer and intra-observer reliability of the new classification and the Schatzker’s classification was conducted by four observers.ResultsThree cases didn’t match any type in the Schatzker’s classification. While on the other hand, all cases were classified by two column classification. The mean kappa values for inter-observer reliability by using the Schatzker’s classification was 0.723 (range, 0.674-0.823), representing substantial agreement, whereas the mean kappa value was 0.939 (range: 0.897-0.974), representing almost perfect agreement according to two column classification. The mean kappa values for intra-observer reliability using the Schatzker’s classification and two column classification were 0.789 (range: 0.590-0.864) and 0.955 (range:0.923-0.948) showing substantial agreement and almost perfect agreement.ConclusionThe quadrant specific two column classification is anatomically oriented, CT based and clinically valid. The different fracture types according to anatomic location are represented alphanumerically so that treatment matched to specific fracture type (quadrant specific anatomic fixation) for optimal outcomes. Furthermore, it demonstrates higher inter-observer and intra-observer reliability. This classification can be adopted to strengthen the traditional Schatzker’s classification, particularly in the multi planar and posteriorly extended plateau fractures. It can be used as a reliable research tool. The database can be used to distinguish different fracture types, individual type incidences, specific treatment and also prognosis. Authors suggest a large multi-centre study.     

A systematic literature review of tibial plateau fractures: What classifications are used and how reliable and useful are they?

IntroductionClassification systems such as the Schatzker and AO/OTA have been proposed for standardised assessment of tibial plateau fractures and to guide clinical decision making. However, there has been no comprehensive literature review of all classification systems for tibial plateau fractures, including assessment of their reliability. The aim of this systematic review was to identify and appraise previously established classification systems for tibial plateau fractures and determine their reliability for fracture classification.MethodsSix databases were searched from inception until October 2016. Classification systems for tibial plateau fractures were identified. No restriction was placed on imaging modality (plain film X-ray, CT, MRI). Data synthesis was performed to identify common features of the systems, their prevalence within the literature and studies of intra and inter-rater reliability of fracture classification using Kappa coefficient (κ).ResultsThirty-eight classification systems were identified, five of which were a sub-classification of a single fracture type from a previous tool. The Schatzker and AO/OTA classification systems were the most commonly reported. Of the tools identified only five have been tested for inter and intra-observer reliability (Schatzker, AO/OTA, Duparc, Hohl and Luo). Reliability of more simplistic classification systems, such as that by Luo et al. (three-column) was typically high (intra-κ = 0.67–0.81, inter-κ = 0.71–0.87), but with the disadvantage of providing less information on fracture patterns and morphology. Intra and inter-observer reliability using plain film X-ray was frequently moderate (κ = 0.40–0.60), with 2D and 3D CT typically improving reliability of classification. Only 11 of the 32 complete classification systems identified association of fracture classification with clinical outcome.DiscussionFrequently used systems for classification of tibial plateau fractures display moderate intra and inter-observer reliability. More sophisticated imaging modalities such as 2D and 3D CT typically improve reliability estimates. Using fracture classification based on imaging findings to predict clinical outcome was not a commonly reported goal of newly developed systems. More detailed assessment of fracture patterns and morphology, in conjunction with information on surgical fixation, may be desirable for predicting outcomes and to guide clinical decision making.