Comparison of Plain Radiography with Spiral Computed Tomography and 3D Reformation in Tibial Plateau Fractures: A Cross-sectional Study

Introduction: Tibial plateau fractures may result in major disabilities if not diagnosed at the right time. Plain radiography is the first and foremost imaging modality of choice to evaluate trauma followed by Computed Tomography (CT). Aim: To evaluate tibial plateau fractures on CT and compare them with 3D reformations and plain radiography, and classify the fractures using Schatzker’s classification. Materials and Methods: The prospective cross-sectional study was conducted at a tertiary care centre in Bengaluru, Karnataka, India, between November 2016 to June 2018. The study sample comprised of 53 patients who presented with fracture of the tibial plateau. Demographic details and brief clinical history of the subjects were recorded. All patients underwent conventional radiography as well as CT of the knee, including three-Dimensional (3D) reconstruction. The region of interest was assessed for the presence, displacement, depression, extent and comminution of the fracture. Data was analysed using R version 4.0.3. Chi-square test was used to see the association between different variables. Cohen’s Kappa was employed to determine the agreement of plain radiograph and CT findings. Results: The mean age of patients was 44.01±13.23 years. The extent of the fracture line and communition of fracture were visible on all sections of CT for all samples, but 3D CT did not reveal the extent of the fracture line in 9.43% of the sample (p=0.003) and communition was visible only in 15.09% of the sample. On comparing the plain radiograph and CT findings for tibial plateau fractures, a close to perfect agreement in diagnosing the displacement of fracture (Cohen’s Kappa, 0.9618, p<0.001), followed by a fair agreement in diagnosing fracture communition (Cohen’s Kappa, 0.3748; p=0.0015) were noted. The positive predictive value of tibial plateau fracture detection rate by plain radiography and CT findings were 88.7% and 98.1%, respectively. These fractures assessed as per Schatzker’s classification revealed majority of the patients had bicondylar plateau with diaphyseal discontinuity 19 (35.85%) followed by bicondylar plateau 14 (26.42%). Conclusion: In this study, CT was observed to be an excellent modality for the evaluation of tibial plateau fractures including depression, displacement, comminution and extent of fractures when compared to plain radiography.