University of Twente Student Theses


Quantitative 3D fracture analysis of complex intra-articular tibial plateau fractures : method development and validation

Assink, N. (2019) Quantitative 3D fracture analysis of complex intra-articular tibial plateau fractures : method development and validation.

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Abstract:Tibial plateau fractures are amongst the most challenging injuries of the knee. Even though adequate treatment of these fractures is crucial, fracture assessment is still performed in 2D. The aim of this study was to develop and validate a standardized method for fracture assessment in 3D. Seven 3D measurement (3D gap, 3D Step-off, articular surface involvement, gap area, 3D displacement, sagittal alignment and axial alignment) were introduced and validated. Reproducibility and repeatability was tested by repeating the measurement for ten patients. Furthermore clinical validation was performed by associating the measurements with the patient related outcome measurement score KOOS and the conversion to a total knee arthroplasty (TKA). A Mann-Whitney U test was performed to test significant differences. A ROC curve was created for all significant measurements and the critical cut-off values were determined. Furthermore survival-curves were created for the conversion to TKA. All measurement besides sagittal and axial alignment were found to have good to excellent reliability. 3D step-off and gap area showed to be significant lower in patients with good functional outcomes than with moderate to poor outcomes. A critical cut-off value of 4 mm and 100 mm2 were determined for step-off an gap area associated with a good outcome (KOOS≥80). Critical cut-off values of 8 mm, 6 mm, 450 mm2 and 1 mm for respectively gap, step-off, gap area and 3D displacement were associated with the conversion to TKA. This study has shown that Q3DCT measurement method of the tibial plateau is feasible and reliable. The measurements have shown with varying degree to be associated with the clinical outcomes.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
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