The influence of pre-operative Computed Tomography (CT) on surgical approach and fixation for fractures of the tibial plateau

• Published in: Journal of orthopaedics 2023-08, Vol.42, p.50-53
• Main Authors: Fleming, Thomas A., Torrie, Peter Alexander G., Murphy, Thomas A., Dodds, Alexander L., Engelke, Daniel M., Curwen, Christopher H.M., Gosal, Harminder S., Pegrum, James
• Format: Article
• Language: English
• Subjects: Classification; Computed tomography; Fracture; Operative plan; Preoperative planning; Review article; Tibial plateau; Trauma
• ISSN: 0972-978X; 0972-978X
• DOI: 10.1016/j.jor.2023.07.004

It is well known that a computed tomography (CT) scan improves the classification of tibial plateau fractures (TPF) compared with radiographs. However, it is less clear how this translates into clinical practice. The aim of this study is to establish to what extent a pre-operative CT scan alters the approach, setup and fixation choice in TPF compared to radiographs. 50 consecutive TPF with a preoperative CT and radiographic imaging available, were assessed by 4 consultant surgeons. First, anonymised radiographs were classifying according to the column classification and the planned setup, approach, and fixation technique documented. At a 1-month interval, randomised matched CT scans were assessed and the same data collected. A tibial plateau disruption score (TPDS) was derived for all 4 quadrants (no injury = 0, split = 1, split/depression = 2 and depression = 3). Radiograph and CT TPDS were assessed using an unpaired T-test. 26 female and 24 male patients, mean age 50.3, were included. Mean TPDS on radiographs and CT scans were 2.77 and 3.17 respectively. A significantly higher CT TPDS, of 0.4 (95%CI 0.10–0.71)[P = 0.0093] was observed, demonstrating that radiographs underestimate the extent of injury. The surgical approach changed in 28.5% of cases, thus influencing a change in the patient setup in theatre in 27% of cases. Identification of fractures within a column changed in 34% of cases. A high intra-observer reliability was observed when surgeons were asked to repeat their assessment in a third round at a further one month interval. A pre-operative CT scan has a significant effect on the approach required to fix TPF. This therefore influences the setup of the patient and can justifiably be requested as part of pre-operative planning. •The addition of a CT scan, compared to radiographs, changed the setup (27%), approach (28.5%) and location of plates (34%) of cases.•A high intra-observer reliability was observed between surgeons and between rounds when CT images were used to form an operative plan.•We feel that the addition of a CT scan influences setup, approach and fixation method and is clinically justified prior to surgery in fractures of the tibial plateau.