title: Computed tomography-based Three-Column Classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility.
abstract: BACKGROUND
  The purpose of our study is to introduce a new Three-Column Classification for tibial plateau fractures and evaluate its reproducibility and reliability.
  
  
  METHODS
  From December 2004 to December 2006, 278 consecutive patients with tibial plateau fractures were treated operatively at the Department of Orthopedics and Trauma III in Shanghai Sixth People's Hospital. Computed tomography (CT) and three-dimensional reconstruction were preformed for each patient before open reduction and internal fixation. The approaches were instructed by the Three-Column Classification. To test the reproducibility of the Three-Column Classification, the interobserver and intraobserver reliability of this classification system compared with that of the Schatzker Classification was investigated by four observers.
  
  
  RESULTS
  Fourteen cases could not be classified by Schatzker Classification. Meanwhile, all cases could be classified by the Three-Column Classification. Using plain radiographs, the mean κ values for interobserver reliability using Schatzker Classification systems were 0.567 (range, 0.513-0.589), representing "moderate agreement," whereas the mean κ values were 0.766 (range, 0.706-0.890), representing "substantial agreement" by the use of the Three-Column Classification based on the CT scan. The mean κ values for intraobserver reliability using Schatzker Classification and the Three-Column Classification based on the CT scan were 0.758 (range, 0.691-0.854) and 0.810 (range, 0.745-0.918), respectively, representing "substantial agreement."
  
  
  CONCLUSIONS
  The Three-Column Classification demonstrates a higher interobserver reliability and can be used as a supplement to the conventional Schatzker Classification, especially in the complex and posterior comminuted tibial plateau fractures. Furthermore, the Three-Column Classification is clinically relevant and, to some degree, can instruct the surgeon in preoperative planning.
  
  
  METHODS
  Diagnostic study, level III.
authors.affiliation: Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhu
authors.forename: Guang
authors.initials: G
authors.lastname: Yang
authors.forename: Cong-Feng
authors.initials: CF
authors.lastname: Luo
authors.forename: Wade R
authors.initials: WR
authors.lastname: Smith
authors.forename: Cheng-Fang
authors.initials: CF
authors.lastname: Hu
authors.forename: Hong
authors.initials: H
authors.lastname: Gao
authors.forename: Biao
authors.initials: B
authors.lastname: Zhong
authors.forename: Bing-Fang
authors.initials: BF
authors.lastname: Zeng
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D021621:Imaging, Three-Dimensional; D057072:Intra-Articular Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008592:Menisci, Tibial / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D015588:Observer Variation; D011300:Preoperative Care / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D013978:Tibial Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery; D000070600:Tibial Meniscus Injuries; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult