Radiographics : a review publication of the Radiological Society of North America, Inc
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Review
Schatzker classification of tibial plateau fractures: use of CT and MR imaging improves assessment.
The Schatzker classification system for tibial plateau fractures is widely used by orthopedic surgeons to assess the initial injury, plan management, and predict prognosis. Many investigators have found that surgical plans based on plain radiographic findings were modified after preoperative computed tomography (CT) or magnetic resonance (MR) imaging. The Schatzker classification divides tibial plateau fractures into six types: lateral plateau fracture without depression (type I), lateral plateau fracture with depression (type II), compression fracture of the lateral (type IIIA) or central (type IIIB) plateau, medial plateau fracture (type IV), bicondylar plateau fracture (type V), and plateau fracture with diaphyseal discontinuity (type VI). ⋯ The fracture-dislocation mechanism of type IV fractures increases the likelihood of injury to the peroneal nerve or popliteal vessels. In type V and VI fractures, the location of soft-tissue injury dictates the surgical approach and the degree of soft-tissue swelling dictates the timing of definitive surgery and the need for provisional stabilization with an external fixator. CT and MR imaging are more accurate than plain radiography for Schatzker classification of tibial plateau fractures, and use of cross-sectional imaging can improve surgical planning.
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Small bowel obstruction (SBO) is a common clinical syndrome for which effective treatment depends on a rapid and accurate diagnosis. Despite advances in imaging and a better understanding of small bowel pathophysiology, SBO is often diagnosed late or misdiagnosed, resulting in significant morbidity and mortality. A comprehensive approach that includes clinical findings, patient history, and triage examinations such as plain abdominal radiography will help the clinician develop an individualized treatment plan. ⋯ If a complete or high-grade obstruction is suspected, cross-sectional studies such as ultrasonography or multidetector CT are used to exclude strangulation. An algorithmic approach to imaging is proposed for the management of SBO to achieve accurate diagnosis of the obstruction; determine its severity, site, and cause; and assess the presence of strangulation. Radiologists have a pivotal role in clinical decision making in cases of SBO by providing answers to specific questions that significantly affect management.