Deep learning for tibial plateau fracture detection and classification.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: “Nynke van der Gaast reports was provided by Radboud University Medical Center. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper”. 11. Indian J Orthop. 2023 Sep 21;57(11):1891-1900. doi: 10.1007/s43465-023-01001-6. eCollection 2023 Nov. Does the Schatzker III Tibial Plateau Fracture Exist? Rasappan K(1), Lim MJ(2), Chua ITH(3), Kwek EBK(4); Singapore Orthopaedic Research CollaborativE (SORCE). Collaborators: Kwek EBK, Chua ITH, Ren Y, Wong MK, Poon KB, Yeo AKS, Chen Y, Kagda FHY. Author information: (1)Department of Orthopaedic Surgery, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074 Singapore. (2)Ministry of Health Holdings, 1 Maritime Square, Singapore, 099253 Singapore. (3)Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433 Singapore. (4)Department of Orthopaedic Surgery, Woodlands Health Campus, 17 Woodlands Dr 17, Singapore, 737628 Singapore. BACKGROUND: The Schatzker classification system for tibial plateau fractures is one of the most commonly used systems. However, there has been controversy if a Schatzker III type fracture truly exists by their original definition. We aimed to correlate the radiographic and CT images of type III fractures, describe the additional propagating fracture patterns and determine if these fractures do exist by their original description. METHODS: This multicenter retrospective cohort observational study included patients with tibial plateau fractures across five trauma centers over 9 years were identified. All X-rays and CT scans were assessed. Two independent fellowship trained, Orthopaedic trauma surgeons reviewed all knee X-rays and classified them according to the Schatzker system. The CTs were subsequently reviewed and the fractures were reclassified based on CT findings. RESULTS: 569 Tibial plateau fractures in 566 patients were analyzed. All X-ray classified Schatzker III fractures were reclassified to a Schatzker II type after review of CT scans by both assessors independently as there were always at least two or more fracture lines propagating from the depressed fragment to the lateral cortex in all cases. The interobserver variability as assessed by the kappa correlation coefficient (κ) for X-rays and CT-based classifications were κ = 0.274 and κ = 0.906, respectively. The majority of cases had two lateral cortical breaks (83.8%). In addition, the depression occurred mostly in the anterolateral and posterolateral positions (60.3%) of the lateral tibial plateau. CONCLUSION: This study did not support the existence of true Schatzker Type III fractures. © Indian Orthopaedics Association 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. DOI: 10.1007/s43465-023-01001-6 PMCID: PMC10593631