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Radiographic detection of lateral plateau involvement in medial tibial plateau fractures (AO/OTA 41-B1.2, 1.3, 3.2 and 3.3)

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

To assess the accuracy of radiographs in detecting the lateral plateau involvement of medial tibial plateau fractures as well as describe the impact of CT on preoperative planning for this specific fracture morphology.

Methods

Radiograph and CT imaging of patients with a Schatzker type IV tibial plateau fractures (AO/OTA 41-B1.2, B1.3 h, B2.2. B3.2, and B3.3) between January 2013 and July 2017 were reviewed by three trauma fellowship-trained orthopedic surgeons to identify fractures of the medial condyle with an intact anterolateral articular surface.

Results

Lateral plateau involvement was identified in 16 (37%) radiographs and 26 (61%) CT images (p = 0.051). Radiographic detection of lateral plateau involvement demonstrated a sensitivity of 62% and specificity of 100%, and radiographs were able to predict the recommendation for surgical intervention for lateral plateau involvement with a positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 60% compared to recommendations based on CT imaging. Radiographs predicted a need for a separate surgical approach with PPV of 63% and NPV of 70% when compared to recommendations based on CT images.

Conclusions

Radiographs are reliable in ruling in lateral plateau involvement of medial plateau fractures, but occult lateral articular extension may only be identified in CT imaging for some cases. Surgical planning may be impacted by CT imaging for this fracture morphology, but further study is warranted to evaluate the correlation between preoperative planning and clinical outcomes.

Level of Evidence

III.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1520 San Pablo Street, Los Angeles, CA, USA

    Mary Kate Erdman, Stephen J. Gibbs, Adam K. Lee & Mark E. Fleming

  2. Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    Douglass W. Tucker

  3. Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA

    Geoffrey S. Marecek

Authors
  1. Mary Kate Erdman
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  2. Stephen J. Gibbs
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  3. Douglass W. Tucker
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  4. Adam K. Lee
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  6. Geoffrey S. Marecek
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Correspondence to Mary Kate Erdman.

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Conflicts of interest

G. S. Marecek receives research support from BoneSupport AB, consulting fees from Globus Medical, Nuvasive, Stryker and Synthes and he is a committee member for the Orthopedic Trauma Association and Western Orthopedic Association. The remaining authors have nothing to disclose.

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Erdman, M.K., Gibbs, S.J., Tucker, D.W. et al. Radiographic detection of lateral plateau involvement in medial tibial plateau fractures (AO/OTA 41-B1.2, 1.3, 3.2 and 3.3). Eur J Orthop Surg Traumatol 32, 1501–1508 (2022). https://doi.org/10.1007/s00590-021-03117-7

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