Quantitative 3D measurements of tibial plateau fractures

N Assink,C H Slump,M J H Witjes,K Ten Duis,A M L Meesters,F F A Ijpma,P Van Ooijen,J P P M De Vries,J Kraeima

doi:10.1038/s41598-019-50887-6

Abstract

Fracture gap and step-off measurements on 2DCT-slices probably underestimate the complex multi-directional features of tibial plateau fractures. Our aim was to develop a quantitative 3D-CT (Q3DCT) fracture analysis of these injuries. CT-based 3D models were created for 10 patients with a tibial plateau fracture. Several 3D measures (gap area, articular surface involvement, 3D displacement) were developed and tested. Gaps and step-offs were measured in 2D and 3D. All measurements were repeated by six observers and the reproducibility was determined by intra-class correlation coefficients. Q3DCT measurements demonstrated a median gap of 5.3 mm, step-off of 5.2 mm, gap area of 235 mm2, articular surface involvement of 33% and 3D displacement of 6.1 mm. The inter-rater reliability was higher in the Q3DCT than in the 2DCT measurements for both the gap (0.96 vs. 0.81) and step-off (0.63 vs. 0.32). Q3DCT measurements showed excellent reliability (ICC of 0.94 for gap area, 1 for articular surface involvement and 0.99 for 3D displacement). Q3DCT fracture analysis of tibial plateau fractures is feasible and shows excellent reliability. 3D measurements could be used together with the current classification systems to quantify the true extent of these complex multi-directional fractures in a standardized way.

Highlights

Tibial plateau fractures represent 1–2% of all fractures in adults and are reported as one of the most challenging injuries of the knee[1]
It has been reported that these classification systems have their limitations, because of their moderate inter-rater reliability[3,9,10]
3D statistical shape models of the tibia were introduced in this journal[18]. These models seem to be a promising tool for assessing anatomical variations and will be helpful in gaining a more patient-specific approach regarding fracture reduction techniques and implant fitting. In line with these developments, we present a quantitative 3D CT (Q3DCT) measurement tool for tibial plateau fractures

Summary

Introduction

Tibial plateau fractures represent 1–2% of all fractures in adults and are reported as one of the most challenging injuries of the knee[1]. 3D statistical shape models of the tibia were introduced in this journal[18] These models seem to be a promising tool for assessing anatomical variations and will be helpful in gaining a more patient-specific approach regarding fracture reduction techniques and implant fitting. In line with these developments, we present a quantitative 3D CT (Q3DCT) measurement tool for tibial plateau fractures. The clinical applicability of these 3DCT measurements would be usage in addition to the current classification systems to assess initial and/or residual displacement, and they might eventually be related to patients reported outcome measures. The goal of this study was to develop a standardized 3D measurement tool to determine quantitatively the extent of the tibial plateau fractures

Objectives

Methods

Results

Conclusion