Abstract
IntroductionThe aim of this study was to evaluate the intraoperative revision rate and reasons for revision following 3D imaging in the management of dislocated articular tibial plateau fractures based on a large patient sample.MethodsThis retrospective cohort study included all patients who underwent open reduction and internal fixation due type B or C tibial plateau fracture according to the AO/OTA classification between August 2001 and December 2017 using intraoperative cone beam CT (3D imaging) for the analysis of fracture reduction and implant placement.The findings of the 3D scan were categorized regarding the amount and type of revision. Furthermore, demographic data was examined.ResultsFive hundred and fifty-nine consecutive fractures were included in the study. Evaluation of the image data records revealed an intraoperative revision due to the usage of 3D imaging in 148 out of 559 cases (26.5%). The most common reasons for an intraoperative revision were insufficient fracture reduction (114 cases) and screw length (21 cases).ConclusionThis study reveals indications for a limited analysis of fracture reduction and implant placement during the operative treatment of dislocated articular tibial plateau fractures using conventional fluoroscopy. In view of the high revision rate during open reduction and internal fixation of tibial plateau fractures due to 3D imaging the usage of intraoperative cone beam, CT may be considered. If this is not possible, a postoperative computed tomography may therefore be reasonable.
Highlights
The aim of this study was to evaluate the intraoperative revision rate and reasons for revision following 3D imaging in the management of dislocated articular tibial plateau fractures based on a large patient sample
For dislocated articular tibial plateau fractures, surgical management is regarded as the gold standard
If the surgeon was satisfied with the reduction result and implant placement in conventional fluoroscopy, a 3D scan was performed with a cone beam computed tomography (CT) (Fig. 1)
Summary
The aim of this study was to evaluate the intraoperative revision rate and reasons for revision following 3D imaging in the management of dislocated articular tibial plateau fractures based on a large patient sample. For dislocated articular tibial plateau fractures, surgical management is regarded as the gold standard. Various osteosynthesis procedures and implants are available for the surgical management. For the intraoperative analysis of fracture reduction and implant placement, conventional fluoroscopy is generally applied [3]. The standard fluoroscopy has limitations with regard to displaying the complex anatomy of the tibial head. Due to the concave shape of the tibial plateau, parts of the tibial head are often overlaid by other bony structures in the beam path of two-dimensional images (this is known as the “summation effect”). A sufficient assessment of the complete articular surface may not be possible [4]
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