What is the most reproducible classification system to assess tibial plateau fractures?

• Published in: International orthopaedics Vol. 41; no. 6; pp. 1251 - 1256
• Main Authors: Millán-Billi, Angélica, Gómez-Masdeu, Mireia, Ramírez-Bermejo, Eduard, Ibañez, Maximiliano, Gelber, Pablo Eduardo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2017
• Subjects: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Observer Variation; Original Paper; Orthopedics; Reproducibility of Results; Retrospective Studies; Tibial Fractures - classification; Tibial Fractures - diagnostic imaging; Tibial Fractures - surgery; Tomography, X-Ray Computed - methods; Young Adult; Tibial plateau; Fracture classification; Interobserver
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-017-3462-x

Purpose Traditional classification systems for tibial plateau fractures (TPF) are based on simple radiographs, and intra- and inter-observer variability is low. The aim was to assess intra- and inter-observer variability using traditional systems and some recently described classification systems of TPF in the interpretation of standard radiographs and bidimensional (2D) and tridimensional (3D) computed tomography (CT). Methods We studied all patients at two centres who underwent TPF surgery over a three-year period. Demographic data (age, sex, BMI) and mechanism of injury were recorded. Four observers classified each TPF according to the Schatzker, AO, Luo, modified Duparc and Khan classification systems. We calculated intra- and inter-observer variability using the Kappa test. Results A total of 112 (71 males) patients were included. Mean age was 47.1 years (range 21–86) and mean BMI was 25.2 ± 3.6. Intra- and inter-observer variability was 0.95 and 0.62 for AO, 0.87 and 0.65 for Schaztker, 0.86 and 0.73 for Luo, 0.56 and 0.37 for the modified Duparc, and 0.43 and 0.25 for Khan classifications. Conclusions Although previous training could be needed, AO, Schatzker and Luo classifications showed a good reproducibility of TPF assessment from a combination of standard radiographs and 2D and 3D CT images. The results using the Modified Duparc and Khan classifications were less favourable and their use is not therefore recommended.