TIBIAL PLATEAU FRACTURE: ROLE AND CONTRIBUTION OF MULTIDETECTOR CT

1
TIBIAL PLATEAU FRACTURE ROLE AND CONTRIBUTION OF
MULTIDETECTOR CT

• SAIDANE, A. DAGHFOUS, A. BEN OTHMEN,
  S. FELAH, L. REZGUI MARHOUL
• Radiology service Trauma center, 1007 Tunis,
  Tunisia

MK11
2
INTRODUCTION

• Tibial plateau fracture occurs mainly in a young
  population
• Its consecutive to direct trauma of the knee,
  generally secondary to traffic accident.
• Only explored by the past by plain radiographs,
  it benefits nowadays of an increasing number of
  CT exploration.
• Our aim is to clarify the role of multidetector
  scanner in its pretherapeutic assessment.

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MATERIAL METHODS

• Retrospective study of 23 patients with fracture
  of the tibial plateau.
• All were explored by plain radiographs of the
  knee and 16 bars CT.
• The volume of acquisition ranged from 1 cm
  above the
• patella to 1 cm below the tibial
  tuberosity.
• No injection of contrast in the all cases.

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MATERIAL METHODS

• Bone and soft tissue filters.
• Reconstruction in the coronal and sagittal plans
• 3D reconstruction using GE Volume Rendring (VR)
• Ten patients were operated
• 13 were followed in externe consultation.

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RESULTS

• Average age 35 years
• Sex ratio (M/W) 5
• Trauma circumstances traffic accident (n9),
  domestic accident (n6) and accident at work
  (n5)
• The tibial plateau fractures were classified
  according to Duparc et Ficat method

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RESULTS

• We found
• 9 fractures of the lateral tibial plateau
• 5 spino-condylar fractures
• 4 medial tibial fractures
• 5 bituberosity fractures
• More than a third of patients has associated
  injuries primarily affecting the fibula
• 1 case was involved in a polytraumatism           
                    

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RESULTS
(B)
(A)
Coronal (A) et sagittal (B) reconstructions
Fracture of the lateral plateau with an
enfoncement measured at 3.7 mm ( ) and an
associated fracture of the lateral femoral
condyle ( )
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RESULTS
3D reconstructions showing the enfoncement (
) and the fracture of the femoral condyle ( )
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RESULTS
(A)
(C)
(B)
Coronal (A), sagittal (B) and 3D (C)
reconstructionscomminutive medial spino-condylar
fracture
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RESULTS
(B)
Axial (B) and coronal (C) reconstructions Commin
utive fracture of the medial plateau with
enfoncement.
(A)
(A) Coronal reconstruction Fracture of the
medial plateau Separation measured at 5mm
(C)
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RESULTS
Comminutive form of bituberosity fractures
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RESULTS
13
RESULTS
Y form of bituberosity fracture
T form of bituberosity fracture
V form of bituberosity fracture
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DISCUSSION

• Tibial plateau fractures are secondary to direct
  trauma on the knee, the more often of a high
  velocity
• Minor trauma may cause similar lesions in case of
  osteoporosis
• Functionnal impotence, pain and knee swelling are
  the main clinical findings     
• 2 classifications are used in both plain
  radiographs and CT
•            

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DISCUSSION

• The first one, used in France and countries
  following the french school, was edicted by
  Duparc and Ficat in 1960 3,4 and distinguish
• Fractures affecting only one plateau (60),
  generally the lateral one, consequently to a
  direct trauma in valgus (for the lateral plateau)
  or varus (for the medial)
• Squamous tuberosity fracture (10)
• Bituberosity fracture (30) in V, Y or T. There
  are also complex and comminutive forms
•            

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DISCUSSION

• The second classification, anounced by Schatzker
  1, divides tibial plateau fractures into 6
  types
• Lateral tibial plateau fracture without
  depression (I)
• Lateral tibial plateau fracture with depression
  (II)
• Compression fracture of the lateral (IIIA) or
  central (IIIB) tibial plateau
• Medial tibial plateau fracture (IV)
• Bicondylar tibial plateau fracture (V)
• Tibial plateau fracture with diaphyseal
  discontinuity (VI)
•            

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DISCUSSION
Classification of Schatzker 2
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DISCUSSION

• Conflicting data exists regarding the benefit of
  a pretherapeutic CT scan in these
  classifications.
• Stroet et al2, Chan et al5. et many others
  did show there were no increase in agreement
  between different observers for classification of
  tibial plateau fractures with the addition of a
  CT scan comparing to radiographies performed
  solely.
• A possible explanation is that CT provides an
  overdose of information, which makes
  classification more difficult.

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DISCUSSION

• However, practically, CT has many advantages
• Easier classification of fractures, especially
  between Schatzker I and II 2
• Modification of surgical plans based on plain
  radiographic findings after CT in 6 to 60 of
  cases by more precisely demonstrating the
  fracture depression and displacement which are
  the most important factors affecting surgical
  management of standard tibial plateau fractures
  (NB 4 mm depression and 2 mm displacement ?
  surgical levels) 1,4

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DISCUSSION

• Diagnosis of associated soft-tissue injuries 1
  
• According to Gardner et al 6, only 1 of
  patients with tibial plateau fractures has
  complete absence of soft-tissue injuries and 77
  have cruciate or collateral ligaments lesions
  that may be suspected in CT
• Moreover, popliteal vessels lesions
  (associated with Schatzker IV) are well
  illustrated by angiographic reconstruction after
  injection of contrast.

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CONCLUSION

• Several studies are questioning the superiority
  of CT in the classification of tibial plateau
  fractures
• However, the scanner offers real practical
  advantages in the choice of treatment modalities
• Besides, the fact that classification
  methods predate the era of the scanner should
  promote new methods more
•  more adapted to the scanner

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REFERENCES

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