WHAT REALLY CHANGES WITH CT IN TIBIAL PLATEAU AND PILON FRACTURES: A REVIEW OF CHANGES IN THE SURGICAL PLAN

Abstract

Tibial plateau and pilon fractures are among the most complex injuries of the
musculoskeletal system. Both types of fractures are characterized by a high degree
of intra-articular involvement, instability, frequent associated soft-tissue injuries,
and high rates of complications, including post-traumatic osteoarthritis. Over the
past 30 years, the role of computed tomography in the management of these injuries
has fundamentally changed, from an adjunctive diagnostic method to a primary tool
determining the treatment strategy, surgical approach, fixation method, and timing
of surgery.
Historically, in the era of conventional radiography, treatment of these
fractures was largely based on the surgeon's experience and ability to mentally
reconstruct three-dimensional anatomy from two-dimensional images. The
probability of errors was high: posterior fragments could be missed, the extent of
intra-articular disruption could be underestimated, and the surgical approach could
be planned incorrectly. The introduction of CT, particularly three-dimensional
reconstruction, has fundamentally changed this situation. Current evidence suggests
that CT examination can not only improve diagnostic accuracy but also shift a
patient from conservative to operative treatment, influence the choice between single
and dual approaches, affect the choice between plate fixation and external fixation,
and ultimately improve functional outcomes.