The pivotal role of the coronal fracture line for a new three-dimensional CT-based fracture classification of bicondylar proximal tibial fractures |
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| Affiliation: | 1. Department of Trauma Surgery, Trauma Center Murnau, Germany;2. Department of Radiology, Trauma Center Murnau, Germany;3. Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria;4. Institute of Biomechanics, Trauma Center Murnau, Germany;1. Hip Injury Department, Henan Provincial Luoyang Orthopedic Hospital, Luoyang City, China;2. Department of Orthopedic Surgery, University of Colorado, Denver Health Medical Center, Denver, CO, USA;1. Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine, Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea;2. Department of Orthopedic Surgey, Samsung Changwon hospital, Sungkyunkwan University, school of medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, 51353, Republic of Korea;1. Division of Plastic and Hand Surgery, University Hospital Zurich, Switzerland;2. Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland;3. Division of Trauma Surgery, University Hospital Zurich, Switzerland;4. Division of Thoracic Surgery, University Hospital Zurich, Switzerland |
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| Abstract: | IntroductionClassical fracture classifications (AO/OTA, Schatzker) are commonly used to characterize bicondylar proximal tibial fractures. However, none of these classifications allows for a treatment algorithm. The aim of our study was to use 3D appearance of these fractures in CT imaging to improve the clinical value of the classification.Materials and methods3D appearance of 81 CT scans of bicondylar proximal tibial fractures were systematically analyzed and were classified in 3 subtypes, based on the fracture lines orientation. The novel classification was compared for reliability and for clinical relevance with AO and Schatzker classification.ResultsA total of 159 fracture lines were identified which were most frequently oriented in sagittal (89/159), and in coronal (41/159) direction. Based on the orientation of the major fracture lines three fracture types were defined. A special emphasis was drawn to the coronal fracture line of the medial plateau leading to a surgical treatment algorithm. Interobserver reliability was analyzed for all 81 patients resulting in an excellent reliability of К = 0.936 for the 3D classification scheme compared to К = 0.720 for the AO/OTA, К = 0.785 for the Schatzker classification. Correlations with clinical parameters were only observed for the 3D classification.DiscussionThe presented classification scheme based on the 3D geometry of bicondylar proximal tibial fractures demonstrates a good reliability of clinical relevance. |
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| Keywords: | Proximal tibial fracture Fracture analysis Reliability AO/OTA classification Schatzker classification |
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