title: The effect of three-dimensional computed tomography reconstructions on preoperative planning of tibial plateau fractures: a case-control series.
abstract: BACKGROUND
  Tibial plateau fractures are a common intra-articular injury for which computed tomography (CT) scans are routinely used for preoperative planning. Three-dimensional reconstructions of CT scans have been increasingly investigated in recent years, however their role has yet to be defined. We wish to investigate the role of three-dimensional computed tomography reconstructions (3D-CT) in the preoperative planning of tibial plateau fractures.
  
  
  METHODS
  Twelve cases of tibial plateau fractures including plain film radiographs and conventional CT scans were distributed to 21 observers (orthopaedic residents and consultants). The observers filled out a preoperative plan checklist created for this study. Three months later the same cases were distributed, in random order, this time including 3D-CT reconstructions. The same preoperative checklists were completed, and compared to the previous checklists.
  
  
  RESULTS
  The preoperative plan checklist was able to detect differences between cases and between observers. No significant differences were detected between the total plan scores when comparing conventional CT to 3D-CT. Sub-analysis of plan specifics (incisions, hardware, adjuncts) was also not significantly different. The level of training of the observer or the fracture complexity did not affect these results.
  
  
  CONCLUSIONS
  No significant changes were made to observer's preoperative plans with the addition of 3D-CT. 3D-CT reconstructions come at a cost to the system, and therefore their usefulness should be investigated prior to widespread use. Our study demonstrates that the addition of 3D-CT reconstructions to the preoperative workup of tibial plateau fractures did not change management plans when compared to plans made using traditional CT-scans.
authors.affiliation: Orthopedic Surgery Residency Training Program, University of Calgary, Calgary, Alberta, Canada. andrewedodd@gmail.com.|Division of Orthopaedic Surgery, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N-4N1, Canada. andrewedodd@gmail.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: Dodd
authors.affiliation: Office of Surgical Research, University of Calgary, Calgary, Alberta, Canada. eoddone@ucalgary.ca.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Oddone Paolucci
authors.affiliation: Division of Orthopaedics, University of Calgary, Calgary, Alberta, Canada. korley2010@gmail.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Korley
mesh_terms: D016022:Case-Control Studies; D057189:Checklist; D002983:Clinical Competence; D005592:Fracture Fixation; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D013977:Tibia / Q000000981:diagnostic imaging* / Q000601:surgery*; D013978:Tibial Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed