title: Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures.
abstract: 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.
authors.affiliation: Department of Trauma Surgery, Affiliated Hospital of Medical College, Qingdao University, Qingdao 266000, PR China. huyanlingqy@126.com
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: Hu
authors.forename: Fa-Gang
authors.initials: FG
authors.lastname: Ye
authors.forename: Ai-Yu
authors.initials: AY
authors.lastname: Ji
authors.forename: Guang-Xi
authors.initials: GX
authors.lastname: Qiao
authors.forename: Hai-Fei
authors.initials: HF
authors.lastname: Liu
mesh_terms: 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*