Inter- and intra-observer variation of the Schatzker and AO/OTA classifications of tibial plateau fractures and a proposal of a new classification system.
BACKGROUND
The aim of this study was to evaluate the intra- and inter-observer variation of the Schatzker and AO/OTA classifications in assessing tibial plateau fractures, using plain radiographs.


METHODS
Fifty tibial plateau fractures were classified independently by six observers as per the Schatzker and AO/OTA classifications, using antero-posterior and lateral plain radiographs. Assessment was done on two occasions, 8 weeks apart.


RESULTS
We found that both the Schatzker and AO/OTA classifications have a high intra-observer (kappa = 0.57 and 0.53, respectively), and inter-observer (kappa = 0.41 and 0.43, respectively) variation. Classification of tibial plateau fractures into unicondylar versus bicondylar and pure splits versus articular depression +/- split conferred improved inter- and intra-observer variation.


CONCLUSIONS
The high inter-observer variation found for the Schatzker and AO/OTA classifications must be taken into consideration when these are used as a guidance of treatment and when used in evaluating patients' outcome. Simply classifying tibial plateau fractures into unicondylar versus bicondylar and pure splits versus articular depression +/- split may be more reliable.
Charalambous
C P
CP
Department of Orthopaedics and Trauma, Manchester Royal Infirmary, Manchester, UK. bcharalambos@hotmail.com
Tryfonidis
M
M
Alvi
F
F
Moran
M
M
Fang
C
C
Samarji
R
R
Samaraji
R
R
Hirst
P
P
D006801:Humans; D015588:Observer Variation; D011859:Radiography; D013978:Tibial Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery