The classification systems for tibial plateau fractures: how reliable are they?
OBJECTIVE
The aim of the study was to assess the inter-observer reliability and intraobserver reproducibility of three different classification systems for tibial plateau fractures.


METHODS
Four observers of various levels of experience classified 50 tibial plateau fractures. The same observers repeated the classification of the same fractures after an interval of 8 weeks. Inter- and intra-observer variability was assessed using the mean kappa co-efficient and the mean percentage of agreement.


RESULTS
For inter-observer reliability, the mean kappa co-efficient values for Arbeitsgemeinschaft für Osteosynthesefragen (AO), Schatzker and Hohl and Moore classifications were 0.36, 0.47 and 0.14, respectively. The mean percentage of agreement was 0.52, 0.59 and 0.34, respectively. For intra-observer reliability kappa-values were 0.80, 0.91 and 0.76 and the mean percentage of agreement was 0.88, 0.93 and 0.85 in the same order.


CONCLUSIONS
Our results show that none of the classification systems were ideal. The Schatzker classification system was superior to the AO and the Hohl and Moore systems both in terms of inter-observer reliability and intra-observer reproducibility. However, there is a need for developing a more comprehensive approach to judge the classification systems.
Maripuri
Subramanyam Naidu
SN
Neville Hall Hospital, Abergavenny, NP7 7EG, UK. naidumsuk@yahoo.co.in
Rao
Prabhakar
P
Manoj-Thomas
Abraham
A
Mohanty
Khitish
K
D006801:Humans; D015588:Observer Variation; D011859:Radiography; D015203:Reproducibility of Results; D013978:Tibial Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology