Robert Pätzold1, Jan Friederichs2, Christian von Rüden3, Stephanie Panzer4, Volker Bühren2, Peter Augat5. 1. Department of Trauma Surgery, Trauma Center Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria; Institute of Biomechanics, Trauma Center Murnau, Germany. Electronic address: robert.paetzold@bgu-murnau.de. 2. Department of Trauma Surgery, Trauma Center Murnau, Germany. 3. Department of Trauma Surgery, Trauma Center Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria; Institute of Biomechanics, Trauma Center Murnau, Germany. 4. Department of Radiology, Trauma Center Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria; Institute of Biomechanics, Trauma Center Murnau, Germany. 5. Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria; Institute of Biomechanics, Trauma Center Murnau, Germany.
Abstract
INTRODUCTION: Classical fracture classifications (AO/OTA, Schatzker) are commonly used to characterize bicondylar proximal tibial fractures. However, none of these classifications allows for a treatment algorithm. The aim of our study was to use 3D appearance of these fractures in CT imaging to improve the clinical value of the classification. MATERIALS AND METHODS: 3D appearance of 81 CT scans of bicondylar proximal tibial fractures were systematically analyzed and were classified in 3 subtypes, based on the fracture lines orientation. The novel classification was compared for reliability and for clinical relevance with AO and Schatzker classification. RESULTS: A total of 159 fracture lines were identified which were most frequently oriented in sagittal (89/159), and in coronal (41/159) direction. Based on the orientation of the major fracture lines three fracture types were defined. A special emphasis was drawn to the coronal fracture line of the medial plateau leading to a surgical treatment algorithm. Interobserver reliability was analyzed for all 81 patients resulting in an excellent reliability of К=0.936 for the 3D classification scheme compared to К=0.720 for the AO/OTA, К=0.785 for the Schatzker classification. Correlations with clinical parameters were only observed for the 3D classification. DISCUSSION: The presented classification scheme based on the 3D geometry of bicondylar proximal tibial fractures demonstrates a good reliability of clinical relevance.
INTRODUCTION:Classical fracture classifications (AO/OTA, Schatzker) are commonly used to characterize bicondylar proximal tibial fractures. However, none of these classifications allows for a treatment algorithm. The aim of our study was to use 3D appearance of these fractures in CT imaging to improve the clinical value of the classification. MATERIALS AND METHODS: 3D appearance of 81 CT scans of bicondylar proximal tibial fractures were systematically analyzed and were classified in 3 subtypes, based on the fracture lines orientation. The novel classification was compared for reliability and for clinical relevance with AO and Schatzker classification. RESULTS: A total of 159 fracture lines were identified which were most frequently oriented in sagittal (89/159), and in coronal (41/159) direction. Based on the orientation of the major fracture lines three fracture types were defined. A special emphasis was drawn to the coronal fracture line of the medial plateau leading to a surgical treatment algorithm. Interobserver reliability was analyzed for all 81 patients resulting in an excellent reliability of К=0.936 for the 3D classification scheme compared to К=0.720 for the AO/OTA, К=0.785 for the Schatzker classification. Correlations with clinical parameters were only observed for the 3D classification. DISCUSSION: The presented classification scheme based on the 3D geometry of bicondylar proximal tibial fractures demonstrates a good reliability of clinical relevance.
Authors: Matthias Krause; Lena Alm; Markus Berninger; Christoph Domnick; Kai Fehske; Karl-Heinz Frosch; Elmar Herbst; Alexander Korthaus; Michael Raschke; Reinhard Hoffmann Journal: Eur J Trauma Emerg Surg Date: 2020-11-05 Impact factor: 3.693