Comparison of Plain Radiograph and Computed Tomography Scan in the Evaluation of Tibial Plateau Fracture
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Abstract
Objective: To compare the accuracy of radiographs (XR) imaging according to computed tomography (CT) scanning in the determination of fracture type (Schatzker classification), characteristics, and to identify indications for surgery in patients with tibial plateau fractures.
Methods: A retrospective study was conducted in 108 patients with tibial plateau fractures who underwent both radiograph and CT scan in Saraburi Regional Hospital from October 2017 to September 2021
Results: According to diagnostic concordance between XR imaging and CT scan, among the 6 types of tibial plateau fractures, type III had perfect concordance; type I, type IV and type VI had weak concordance; whereas type II and type V had minimal concordance between XR imaging and CT scan in determining the fracture characteristics with indication for surgery. For the XR findings of intra-articular displacement of ≥ 2 mm, metaphyseal-diaphyseal translation > 1 cm and angular deformity of > 10° (when compared with CT scanning), all of these three characteristic features for indication of surgery had both specificity and positive predictive value of 100%, but the sensitivity was only 43%, 52% and 56%, respectively, with negative predictive value of 62%, 88% and 88%, respectively. The concordances between XR imaging and CT scan in determining intra-articular displacement of ≥ 2 mm, metaphyseal-diaphyseal translation > 1 cm and angular deformity > 10° were weak, moderate and moderate, respectively.
Conclusion: Performing only XR imaging is insufficient to evaluate type of fracture and the indications for surgery in tibial plateau fractures, and additional CT scanning is needed for accurate assessment of severity, as well as surgical planning.
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