Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures.
OBJECTIVE
The purpose of this study was to determine whether three-dimensional reconstructed computed tomography (CT) images can improve intra-observer and inter-observer reliability for classification systems of tibial plateau fractures compared to plain radiographs and two-dimensional CT images.


METHODS
Twenty-one tibial plateau fractures were classified independently by four attending orthopaedic trauma surgeons using the AO/ASIF and Schatzker classification systems. First, a combination of plain radiographs and two-dimensional (2D) CT images were evaluated. Second, 4 weeks later, plain radiographs and three-dimensional (3D) CT images were assessed. Then, 4 weeks later, these two rounds of evaluation were repeated. The intra-observer and inter-observer reliability were assessed using kappa statistics.


RESULTS
Three-dimensional CT images can improve the inter-observer and intra-observer reliability regarding both AO/ASIF and Schatzker classification systems of tibial plateau fractures compared to 2D CT images. The degree of agreement of the inter-observer and intra-observer reliability among four surgeons increased from 'substantial' to 'almost perfect'.


CONCLUSIONS
Three-dimensional CT is a more reliable radiographic modality than 2D CT in evaluation of fracture patterns in tibial plateau fractures. This finding seems to show that more sophisticated imaging techniques can improve the reliability of fracture classification systems.
Hu
Yan-Ling
YL
Department of Trauma Surgery, Affiliated Hospital of Medical College, Qingdao University, Qingdao 266000, PR China. huyanlingqy@126.com
Ye
Fa-Gang
FG
Ji
Ai-Yu
AY
Qiao
Guang-Xi
GX
Liu
Hai-Fei
HF
D000328:Adult; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D013978:Tibial Fractures / Q000145:classification* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*