Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures

Jos J Mellema,Peter L Althausen,Ole Brink,Job N Doornberg,Thomas Mittlmeier,Tomo Havliček,Golovakha M Leonidovich,Diederik O Verbeek,Balázs Patczai,Heidi Haapasalo,Rodrigo Pesantez,Michael J Prayson,Nikolaos Lasanianos,Frede Frihagen,Marinis Pirpiris,Paul Ousema,Anže Kristan,Nikolaos Manidakis,Nikolaos E Koukoulias,Samir Mehta,J Lawrence Marsh,Samy Bouaicha,Minos Tyllianakis,Vincenzo Giordano,Valentin Neuhaus,S Wojtek,Antonio Barquet,Milind Merchant,George C Babis,Kyle J Jeray,Ladislav Mica,Christos Garnavos,Parag Melvanki,Rik J Molenaars,Inge Van Rensen,Peter Kloen,Pradeep Choudhari,Mário Vale,Max Van Den Bogaert,David Ring,Lars C Borris,Harish Kurup,Alar Toom,M P A Menon ,J.r Lansdaal ,Richard Jenkinson ,William Dias Belangero ,A Grauls ,B.e Kreis ,James Davenport ,Yoram A Weil ,Ian A Harris ,D H Park ,P Schandelmaier ,Michel Pj Van Den Bekerom ,Tim Schepers ,F J Seibert ,Alan T Kawaguchi ,Ewe Juan Yeap ,Sven H Van Helden ,K Kabir ,Adilson Luiz Ramos ,A Jubel ,Daniël Haverkamp ,Daniel Sá Da Costa ,Chegini M H Shahriar ,João Vide ,Marc F Swiontkowski ,Nicolò Martinelli ,Santhana Kannan ,Edward J Harvey ,Brian Cross ,Robert Zura ,Francesco Lijoi ,Henry M Broekhuyse ,Harold Alonso Villamizar ,Matthew A Mormino ,Chad P Coles ,E Stojkovska Pemovska ,Andreas Engvall ,Julius A Bishop ,Theodoros H Tosounidis ,H Goost ,H Van Der Heide ,S.a.g Meylaerts ,Peter R Brink

doi:10.1016/j.injury.2015.12.022

Abstract

IntroductionTibial plateau fracture classification systems have limited interobserver reliability and new systems emerge. The purpose of this study was to compare the reliability of the Luo classification and the Schatzker classification for two-dimensional computed tomography (2DCT) and to study the effect of adding three-dimensional computed tomography (3DCT). Materials and MethodsEighty-one observers, orthopedic surgeons and residents, were randomized to either 2DCT or 2D- and 3DCT evaluation of a spectrum of 15 complex tibial plateau fractures using web-based platforms in order to classify according to the Schatzker and according to Luo's Three Column classification. Reliability was calculated with the use of Siegel and Castellan's multirater kappa measure. Kappa values were interpreted according to the categorical rating by Landis and Koch. ResultsOverall interobserver reliability of the Schatzker classification was significantly better compared to the Luo classification (kSchatzker=0.32 and kLuo=0.28, P=0.021), however, ‘fair’ for both fracture classification systems. For the Schatzker classification observers agreed significantly better on 2DCT compared to 2D- and 3DCT (k2DCT=0.37 and k2D+3DCT=0.29, P<0.001). The addition of 3DCT did not improve the overall interobserver reliability for the Luo classification as well, as kappa values were not significantly different on 2DCT and 2D- and 3DCT (k2DCT=0.31 and k2D+3DCT=0.25, P=0.096). ConclusionsThe agreement between observers was significantly better for the Schatzker classification compared to Luo's Three Column classification, however agreement was fair for both classification systems. Furthermore, the addition of 3DCT reconstructions did not improve the reliability of CT-based evaluation of tibial plateau fractures. Considering that new classification systems and 3DCT do not seem to improve agreement between surgeons, other efforts are needed that lead to more reliable diagnosis of complex tibial plateau fractures.

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