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

Jos J Mellema; Job N Doornberg; Rik J Molenaars; David Ring; Peter Kloen; Traumaplatform Study Collaborative & Science of Variation Group

doi:10.1016/j.injury.2015.12.022

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

Journal article

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Peer reviewed

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

Jos J Mellema, Job N Doornberg, Rik J Molenaars, David Ring, Peter Kloen and Traumaplatform Study Collaborative & Science of Variation Group

Injury, Vol.47(4), pp.944-949

04/2016

DOI: 10.1016/j.injury.2015.12.022

PMID: 26777468

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https://corescholar.libraries.wright.edu/orthopaedics/78View

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Abstract

Tibial 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). Eighty-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. Overall 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). The 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.

Humans

Imaging, Three-Dimensional

Knee Injuries - classification

Knee Injuries - diagnostic imaging

Observer Variation

Radiographic Image Interpretation, Computer-Assisted

Reproducibility of Results

Sensitivity and Specificity

Tibial Fractures - classification

Tibial Fractures - diagnostic imaging

Tomography, X-Ray Computed - methods

Details

Title: Subtitle: Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures
Creators: Jos J Mellema - Harvard University
Job N Doornberg - University of Amsterdam
Rik J Molenaars - University of Amsterdam
David Ring - Harvard University
Peter Kloen - University of Amsterdam
Traumaplatform Study Collaborative & Science of Variation Group
Contributors: J Lawrence Marsh (Contributor) - University of Iowa, Orthopedics and Rehabilitation
Resource Type: Journal article
Publication Details: Injury, Vol.47(4), pp.944-949
DOI: 10.1016/j.injury.2015.12.022
PMID: 26777468
NLM abbreviation: Injury
ISSN: 0020-1383
eISSN: 1879-0267
Language: English
Date published: 04/2016
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984303964302771

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