Value of three-dimensional computed tomography reconstruction in the treatment of posterior tibial plateau fractures.

BACKGROUND: Indication for surgical treatment of posterior tibial plateau fractures (TPFs) remains up for debate. Three-dimensional computed tomography (3D-CT) reconstruction can provide insight into fracture morphology and could improve treatment strategy and surgical planning. In this study, we investigated the value of 3D-CT reconstruction in the treatment of posterior TPF and evaluated the influence on surgical decision-making.

METHODS: CT images of 34 cases with a TPF involving the posterior column were included and digitally presented to a panel of five international observers at two intervals. At the first evaluation, only coronal, axial and sagittal images were shown. After an interval of at least three weeks, 3D-CT reconstruction images were added. During both surveys, observers were asked to classify the TPF according to the revised three-column classification (rTCC), as well as to define operative strategy.

RESULTS: When using 2D images, overall multirated kappa value was 0.48, with an average pairwise agreement of 68%. After adding 3D images, overall multirated kappa value was 0.43, with average pairwise agreement of 67%. Hierarchical logistic regression of decision to operate on image condition (3D vs. 2D) shows an odds ratio of 2.01 (95% confidence interval, 1.11-3.67), P = .022. Increase in operative indication was seen mainly in posterolateral fractures.

CONCLUSION: This study investigated the value of 3D classification in the treatment of posterior column TPF. Contrary to expectations, the addition of 3D images to the assessment did not reduce but rather appeared to increase operative indications, especially in fractures involving the posterolateral region.