What are the radiological outcomes of arthroscopic reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) for tibia plateau fractures?

Radiological Outcomes of ARIF versus ORIF for Tibial Plateau Fractures

Arthroscopic reduction and internal fixation (ARIF) provides superior radiological outcomes compared to open reduction and internal fixation (ORIF) for Schatzker type I-III tibial plateau fractures, with better preservation of articular surface and fewer post-traumatic osteoarthritic changes.

Radiological Assessment of Tibial Plateau Fractures

• CT imaging is the gold standard for classification and characterization of tibial plateau fracture severity, with 100% sensitivity compared to 83% sensitivity for plain radiographs 1
• MRI is the preferred imaging modality for evaluating additional radiographically occult fractures and associated soft tissue injuries in tibial plateau fractures 1
• The amount of articular surface depression on CT is a predictor of meniscal and ligamentous injuries and can guide the decision for additional MRI evaluation 1

Comparative Radiological Outcomes

• ARIF demonstrates better modified Rasmussen radiological scores (8.42 ± 2.24) compared to ORIF (7.33 ± 1.83) for Schatzker type I-III tibial plateau fractures 2
• ARIF technique allows for more accurate visualization and reduction of articular fragments, particularly in Schatzker type II-III-IV fractures 3
• CT-reconstructed images enhance morphological subclassification of medial tibial plateau fractures (Schatzker type IV) with common involvement of posterolateral quadrants 1

Clinical Correlation with Radiological Outcomes

• Better radiological outcomes with ARIF correlate with superior clinical results, with mean Knee Society Scores of 92.37 (± 6.3) for ARIF versus 86.29 (± 11.54) for ORIF 2
• Rasmussen clinical scores average 27.62 ± 2.60 for ARIF compared to 26.81 ± 2.65 for ORIF, demonstrating correlation between improved radiological and clinical outcomes 3
• HSS (Hospital for Special Surgery) scores show better results with ARIF (76.36 ± 14.19) compared to ORIF (73.12 ± 14.55) 3

Fracture Type-Specific Radiological Outcomes

• For Schatzker type I fractures, no significant differences exist between ARIF and ORIF radiological outcomes 3
• ARIF demonstrates superior radiological outcomes for Schatzker type II-III-IV fractures compared to ORIF 3
• For complex Schatzker type V-VI fractures, both ARIF and ORIF show comparable radiological outcomes, though ARIF has lower infection rates when indicated 3

Associated Soft Tissue Injuries and Radiological Assessment

• MRI is superior for evaluating bone marrow contusions, occult fractures, meniscal injuries, and ligamentous injuries associated with tibial plateau fractures 1
• ARIF allows for direct visualization and treatment of associated intra-articular lesions, with meniscal tears found and treated in 42.5% of patients 2
• Lateral tibial plateau depression >11 mm on preoperative CT scans indicates higher risk of lateral meniscus tear and ACL avulsion fracture 1

Complications Affecting Radiological Outcomes

• ARIF demonstrates lower rates of post-traumatic osteoarthritis compared to ORIF, particularly in Schatzker type II-III-IV fractures 3
• Radiographic osteoarthritis is more common with external fixation compared to ORIF for complex tibial plateau fractures 4
• Worst radiological results are associated with concomitant intra-articular lesions regardless of fixation method 2

Long-term Radiological Outcomes

• ARIF demonstrates better maintenance of joint congruity and less secondary displacement in medium to long-term follow-up 3
• For Schatzker type V and VI fractures, both ARIF and ORIF have poor medium and long-term radiological results, but ARIF is preferred when indicated due to lower infection rates 3
• Radiological evidence of osteoarthritis is more common in external fixation compared to ORIF, though there is no difference in the need for total knee arthroplasty between treatment modalities 4

Practical Considerations for Radiological Assessment

• Initial evaluation should include standard 3-view radiographs of the knee 1
• CT imaging should be obtained for better characterization of fracture pattern and DRUJ involvement for surgical planning 5
• MRI should be considered when soft tissue injuries are suspected, particularly for evaluation of meniscal and ligamentous structures 1