Automatic segmentation of knee CT images of tibial plateau fractures based on three-dimensional U-Net: Assisting junior physicians with Schatzker classification

Purpose: This study aimed to automatically segment knee computed tomography (CT) images of tibial plateau fractures using a three-dimensional (3D) U-net-based method, accurately construct 3D maps of tibial plateau fractures, and examine their usefulness for Schatzker classification in clinical practice. Methods: We retrospectively enrolled 234 cases with tibial plateau fractures from our hospital in this study. The four constituent bones of the knee were manually annotated using ITK-SNAP software. Finally, image features were extracted using deep learning. The usefulness of the results for Schatzker classification was examined by an orthopaedic and a radiology resident. Results: On average, our model required < 40 s to process a 3D CT scan of the knee. The average Dice coefficient for all four knee bones was higher than 0.950, and highly accurate 3D maps of the tibia were produced. With the aid of the results of our model, the accuracy, sensitivity, and specificity of the Schatzker classification of both residents improved. Conclusions: The proposed method can rapidly and accurately segment knee CT images of tibial plateau fractures and assist residents with Schatzker classification, which can help improve diagnostic efficiency and reduce the workload of junior doctors in clinical practice.