Tibial plateau fractures: evaluation with multidetector-CT

PURPOSE: To evaluate the role of Multislice CT (MSCT) in classifying tibial plateau fractures and deciding on the appropriate therapeutic treatment compared to conventional radiology. MATERIALS AND METHODS: Twenty-five patients with a clinical diagnosis of tibial plateau fracture were studied with plain film and MSCT. The CT images were reconstructed with MPR and 3D technique and the fractures classified according to the Swiss AO-ASIF classification. The following radiographic and CT parameters were used: fracture location and size, number of fragments or degree of depression of fracture; plateau area involved; surgical access; degree of osteoporosis and bone tissue loss. RESULTS: The plain film and MSCT classification showed agreement in 48% of cases and disagreement in 52%. MSCT better demonstrated disruption of the tibial plateau surface and showed a larger number of fragments. In 60% of patients the CT features led the orthopaedist to modify the treatment. In three patients CT demonstrated bone tissue loss, suggesting for bone graft. In four patients CT showed alteration of the bone architecture and suggested the use of different material for osteosynthesis. Compared to axial CT, the MSCT MPR and 3D reconstructions enabled a more accurate assessment of plateau depression, and of rotation and separation of the fragments. The 3D technique proved better than MPR in evaluating rotation of fractured fragments as it provides an overall view as well as the possibility of rotating the bone segments. CONCLUSIONS: MSCT and 3D reconstructions are very useful for classifying tibial plateau fractures and for preoperative assessment. Patients with clinical evidence of fracture might benefit from an examination with CT instead of conventional radiology.