RESEARCH SUPPORT, NON-U.S. GOV'T
Add like
Add dislike
Add to saved papers

Two-dimensional and three-dimensional computed tomography for the classification and characterisation of tibial plateau fractures.

Injury 2011 December
BACKGROUND: Complex tibial plateau fractures can be difficult to characterise on plain radiographs and two-dimensional computed tomography (2D CT). The present study evaluated whether three-dimensional computed tomography (3D CT) reconstructions can improve the reliability of complex tibial plateau fracture characterisation and classification.

METHODS: Forty-five consecutive intra-articular fractures of the tibial plateau were evaluated by six independent observers for classification according to standard systems and for the presence of six characteristics: (1) posteromedial shear fracture; (2) coronal plane fracture; (3) lateral condylar impaction; (4) medial condylar impaction; (5) tibial spine involvement; and (6) separation of tibial tubercle necessitating fixation. Two rounds of characterisation and classification were performed: the first classification after a combination of plain radiographs and 2D CT and the second one after 3D CT information were added.

RESULTS: 3D CT improved the average 'inter'-observer reliability of the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification (κ2D=0.536, 95% confidence interval (CI): 0.481-0.591 vs. κ3D=0.545, 95% CI: 0.478-0.612), the Hohl and Moore classification (κ2D=0.668, 95% CI: 0.605-0.732 vs. κ3D=0.746, 95% CI: 0.605-0.732) and of the Schatzker classification (κ2D=0.545, 95% CI: 0.494-0.596 vs. κ3D=0.596, 95% CI: 0.538-0.654). 'Intra'-observer reliability also improved non-significantly for all systems after the addition of 3D CT for individual observers. 3D CT did improve the 'intra'-observer reliability for the identification of the following fracture characteristics: coronal plane fracture (average κ2D=0.700, interquartile range (IQR): 0.551-0.820 vs. average κ3D=0.774, IQR: 0.692-0.847); lateral condylar impaction (average, κ2D=IQR: 0.675-0.901 to 1.000 vs. average, κ3D=0.785, IQR 0.737-0.807); medial condylar impaction (average κ2D=0.631, IQR: 0.537-0.670 vs. κ3D=0.719, IQR: 0.679-0.895); tibial spine involvement average (κ2D=0.621, IQR 0.545-0.678 vs. average κ3D=0.705, IQR: 0.652-0.794); separation of tibial tubercle necessitating fixation (average κ2D=0.332, IQR: 0.080-0.574 vs. average κ3D=0.441, IQR: 0.325-0.681). The only improvement that was found to be statistically significant was for recognition of medial condylar impaction as the IQR did not overlap. 3D CT had limited influence on average 'inter'-observer reliability for the recognition of all specific fracture characteristics (κ2D=0.488 vs. κ3D=0.485, both moderate agreement for all fracture characteristics) but showed a non-significant improvement of the recognition of coronal plane fractures (fair to moderate; κ2D=0.398, 95% CI: 0.273-0.523 to κ3D=0.418, 95% CI: 0.262-0.574) and recognition of impaction of the lateral condyle (κ2D=0.614, 95% CI: 0.467-0.760 to κ3D=0.693, 95% CI: 0.538-0.849).

CONCLUSIONS: The added value of 3D CT after 2D CT is limited and does not significantly improve reliability of characterisation and classification of tibial plateau fractures.

Full text links

For the best experience, use the Read mobile app

Group 7SearchHeart failure treatmentPapersTopicsCollectionsEffects of Sodium-Glucose Cotransporter 2 Inhibitors for the Treatment of Patients With Heart Failure Importance: Only 1 class of glucose-lowering agents-sodium-glucose cotransporter 2 (SGLT2) inhibitors-has been reported to decrease the risk of cardiovascular events primarily by reducingSeptember 1, 2017: JAMA CardiologyAssociations of albuminuria in patients with chronic heart failure: findings in the ALiskiren Observation of heart Failure Treatment study.CONCLUSIONS: Increased UACR is common in patients with heart failure, including non-diabetics. Urinary albumin creatininineJul, 2011: European Journal of Heart FailureRandomized Controlled TrialEffects of Liraglutide on Clinical Stability Among Patients With Advanced Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial.Review

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app

Read by QxMD is copyright © 2021 QxMD Software Inc. All rights reserved. By using this service, you agree to our terms of use and privacy policy.

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app