| Discussion: |
In the surgical planning of a patient with a tibial plateau fracture, an important question is whether the fracture is depressed, and if so, how much. Fractures that are non-displaced or only depressed less than 3 mm may do well without surgical reduction. Depression greater than 3 mm is usually an indication for open reduction and internal fixation. This may be hard to determine on plain radiographs alone. In the days of yore, such patients were worked up next with tomography. Nowadays, tomography units have mostly been phased out, with the tomo room usually converted to a CT suite or some other use. This patient had both examinations.
Last 2 images show that the depression is probably about 2 - 3 mm. Which method is best for depicting the depression? With state of the art CT and thin section cuts, we feel that CT is just as good as a tomogram for showing the amount of depression and far superior to a tomogram in showing the presence, number and orientation of all of the fracture planes and fragments.