Computed tomography of tibial plateau fractures

Open reduction with internal fixation of tibial plateau fractures in performed frequently. Factors that must be considered in planning treatment include the patient's age and physical condition, the presence and degree of plateau depression, the presence and degree of separation of split fragments, and the severity of fracture comminution. Twenty patients with tibial plateau fractures were studied by conventional tomography and computed tomography (CT) in order to determine the role and feasibility of CT in management of such patients. CT resulted in less discomfort to the patient and provided optimal visualization of the plateau defect and the split fragments. It proved more accurate than conventional tomography in assessing depressed and split fractures when they involved the anterior or posterior border of the plateau and in demonstrating the extent of fracture comminution. Split fragments with an oblique plane of fracture also were seen better by CT. The degree of fracture depression and separation as measured by the computerized technique was often more accurate than measurements obtained from conventional tomograms. In three patients, treatment was changed on the basis of the CT findings. In three other cases, the classification was altered without a change in treatment.