Classification systems for tibial plateau fractures; does computed tomography scanning improve their reliability?
BACKGROUND
The purpose of this study was to evaluate the impact of computed tomography scanning on the inter- and intra-observer reliability of the OTA/AO, the Schatzker, and the Hohl classifications in the assessment of tibial plateau fractures.


METHODS
Four independent observers classified 45 consecutive fractures of the tibial plateau according to the criteria of the OTA/AO system, the Schatzker classification, and the Hohl classification. Two sessions of readings were compared; first, the use of plain anterior-posterior and lateral X-rays alone was evaluated, then 4 weeks later the combination of plain X-rays and two-dimensional computed tomography scans were evaluated. The readings were repeated 8 weeks later to evaluate intra-observer reliability.


RESULTS
The three classification systems showed "moderate" inter-observer reliability and "good" and "moderate" intra-observer reliability when classified solely on the basis of plain radiographs. After the addition of computed tomography scans inter-observer reliability significantly improved to "good" in all classifications. Likewise, intra-observer reliability improved to "good" in all classifications after the addition of CT-scans. Statistical analysis showed no significant difference regarding inter- and intra-observer agreement between the three classifications.


CONCLUSIONS
Computed tomography scanning improved the inter- and intra-observer reliability of the OTA/AO, the Schatzker, and the Hohl classification. Overall, all three classification systems showed "good" inter- and intra-observer reproducibility when classified with CT-scans.
Brunner
Alexander
A
Department of Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland. a-r.brunner@web.de
Horisberger
Monika
M
Ulmar
Benjamin
B
Hoffmann
Alexander
A
Babst
Reto
R
D002983:Clinical Competence; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D015588:Observer Variation; D013978:Tibial Fractures / Q000145:classification* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed