EVALUATION OF TIBIAL PLATEAU FRACTURES - EFFICACY OF MR-IMAGING COMPARED WITH CT

OBJECTIVE. CT is often used after plain films to evaluate fractures of the tibial plateau. Because MR imaging can show associated soft-tissu e injuries as well as fractures, we hypothesize that MR is superior to CT for imaging these injuries. Accordingly, we compared the efficacy of MR imaging and CT in 22 patients with tibial plateau fractures. SUB JECTS AND METHODS. CT with two-dimensional reconstruction and MR exami nations were performed in 22 patients with tibial plateau fractures. T he images were interpreted by four radiologists and two orthopedic sur geons. Findings on CT scans and plain films were used to determine the configuration of the fractures and to classify them according to the Schatzker system. This was done with findings on MR images and plain f ilms at a separate session. The MR images were also evaluated for liga mentous and meniscal injuries. A qualitative side-by-side comparison o f two-dimensional CT scans and MR images for depiction of fracture con figuration was done. imaging results were correlated with observations from physical examinations in all patients and with surgical findings in 12 patients. RESULTS. All of the six types of fractures of the Sch atzker classification were observed in this series. Comparison of two- dimensional CT reconstructions and MR images for depiction of fracture configuration revealed that the two techniques were equal in 14 patie nts, MR imaging was superior to CT in five patients, and CT was superi or to MR imaging in three patients (who had very complex and comminute d fractures). In addition, MR imaging showed 12 complete ligamentous t ears and 15 partial ligamentous tears in 15 (68%) of the 22 patients. MR showed meniscal injuries in 12 (55%) of the 22 patients. CONCLUSION . MR imaging was equivalent or superior to two-dimensional CT reconstr uction for depiction of fracture configuration in most patients. In ad dition, MR showed significant soft-tissue injuries. We believe that MR imaging is the preferable imaging technique for most patients with fr actures of the tibial plateau.