From the Guidelines
CT scan is the diagnostic test of choice for a tibial plateau fracture.
Reasons for Choosing CT Scan
- CT scans have been shown to be superior to knee radiographs in detection and classification of fractures, with a sensitivity of 100% in detecting tibial plateau fractures 1.
- CT scans are useful in further characterization of fracture severity and can predict or diagnose ligamentous injuries 1.
- CT scans can also help predict meniscal injuries, with the amount of articular surface depression on CT being a predictor of meniscal and ligamentous injuries 1.
Comparison with Other Imaging Modalities
- MRI is also a useful imaging modality, especially for evaluating internal derangements of the knee, such as meniscal and ligamentous injuries 1.
- However, CT scans are equivalent alternatives to MRI in evaluating additional bone or soft-tissue injury after a radiographic diagnosis of tibial plateau fracture 1.
Key Points
- CT scans have high sensitivity and specificity in detecting bony avulsion fractures and can reliably diagnose ligamentous injuries 1.
- CT scans can also detect post-traumatic bone marrow contusions and possibly grade them 1.
- The use of CT scans can help guide treatment and management of tibial plateau fractures, especially in cases where ligamentous or meniscal injuries are suspected 1.
From the Research
Diagnostic Tests for Tibial Plateau Fractures
- The diagnostic test of choice for a tibial plateau fracture is not explicitly stated in the provided studies, but the following tests are mentioned as useful in diagnosis:
- Plain radiographs: can show fat-fluid level in the suprapatellar bursa, malalignment of the femoral condyles and tibial edges, and increased trabecular density in the lateral epicondyle 2
- Computerized Tomography (CT) imaging: useful in preoperative planning and can reveal recurrent patterns of fracture lines and fragments 3
- CT mapping: can aid in understanding the configuration of the fracture and identifying major patterns of fracture and comminution 3
Imaging Recommendations
- Patients with suspected tibial plateau fracture and negative radiographs should have CT imaging performed 2
- CT is seen as a useful diagnostic modality in preoperative planning for tibial plateau fractures 3
Classification and Diagnosis
- The Schatzker classification is commonly used to classify tibial plateau fractures 3, 4
- Understanding the anatomy and configuration of the fracture is important for diagnosis and management 4
- A comprehensive understanding of the fracture morphology, ligamentous and neurovascular injuries, as well as diagnostic and therapeutic options is required for optimal clinical outcome 5