Summary

New created software quantifies tibial plateau articular depression and correlates with meniscal injuries in tibial plateau fractures

Abstract

Introduction

Tibial plateau fractures (TPF) have an incidence of 10 in 100,000 patients and of 90% cases have an associated soft tissue injury (ASTI). Although intraoperative arthroscopy and preoperative magnetic resonance imaging (MRI) are described as diagnostic tools for this condition, they are not routinely performed. In the literature, joint depression (JD), typically quantified by its area or depth using Computed Axial Tomography (CT), has been associated with the presence of ASTI. However, the association between the volume of JD and associated soft tissue injuries has not yet been described.

OBJECTIVES
To evaluate the association between the volume of joint depression in TPF and the presence of soft tissue injuries in patients treated at a trauma center.

Methods

Cross-sectional diagnostic study. Patients with TPF who underwent surgery and had preoperative CT and MRI studies were included. CT segmentation was performed using the 3DSlicer program. A custom-developed software was created in MATLAB to calculate the volume of the JD. The method followed self-explanatory steps to generate a three-dimensional map of the JD, from which the volume of the depression (in mm³) and its central point were calculated (Figure 1). The MRIs, reported by musculoskeletal radiologists, were also evaluated. A p-value < 0.05 was considered statistically significant.

Results

The sample included 93 patients, 66% of whom were men, with an average age of 46 years. The TPF were classified as 62 Schatzker II, 14 Schatzker III, 2 Schatzker IV, and 15 Schatzker V. The median joint depression volume was 2,643 mm³ with an interquartile range (IQR) of 1,251-3,509 mm³, a minimum of 46 mm³, and a maximum of 17,700 mm³. ASTI was present in 72 (77.4%) of the fractures, including 39 lateral meniscus injuries and 30 involving some component of the posterolateral corner.

There was a significant association between joint depression volume and meniscus injury of the fractured plateau (p = 0.04) compared to injuries involving both menisci or no injury. However, there was no significant association between the JD volume and any other ligament injury (p = 0.7)

Discussion

The volume of the joint depression does not correlate with the presence of soft tissue injuries; however, when specifically comparing meniscal injuries to the evaluated plateau, an association was found. This study provides the first description of

Method

to assess joint depression in a fractured tibial plateau and its association it with soft tissue injuries.