Importance of CT Scan in Predicting the Outcomes of Tibial Plateau Fractures: A Retrospective Study of 216 Patients over 10 Years' Time.

BACKGROUND: The primary aim of this retrospective study was to assess the postoperative clinical, functional, and radiographic outcomes of patients with closed tibial plateau fractures (TPFs) surgically treated with proximal tibial locking compression plate (LCP) system with a focus on the use of preoperative CT scan.
METHODS: Two hundred and sixteen patients with TPFs who underwent surgical treatment in our department between January 2010 and December 2019 were enrolled in this study. Ninety-five patients of 216 (44.0%) had preoperative CT examination in addition to plain radiographs to better evaluate the pattern of fracture and displacement of fragments. Clinical and functional outcomes were assessed using VAS, SF-36, Knee Society Score (KSS) and WOMAC score. Radiographic outcomes were evaluated according to the Kellgreen- Lawrence classification of the pre- and postoperative grades of valgus knee, articular displacement and gonarthrosis.
RESULTS: Patients with preoperative CT showed better clinical results than the X-ray group for the VAS, KSS, WOMAC and SF-36 score. Moreover, we found that the X-ray group had worse results than the CT group in the rate of varus-valgus alignment and step-off worsening, while the posterior tibial slope showed no significant changes between the two groups at the final follow-up. Finally, the group of patients who received preoperative CT scans displayed a better immediate postoperative reduction and less long-term arthritis.
CONCLUSION: CT has proved to be a good examination in preoperative planning of TPFs: it can influence postoperative results thanks to an improvement in the surgical approach, a better evaluation of the morphology of fracture lines and the involvement of the Luo's three columns in axial CT scans. © Indian Orthopaedics Association 2021.