title: Objective Metric of Energy Absorbed in Tibial Plateau Fractures Corresponds Well to Clinician Assessment of Fracture Severity.
abstract: OBJECTIVE
  Determine the agreement between subjective assessments of fracture severity and an objective computed tomography (CT)-based metric of fracture energy in tibial plateau fractures.
  
  
  METHODS
  Six fellowship-trained orthopaedic trauma surgeons independently rank-ordered 20 tibial plateau fractures in terms of severity based on anteroposterior and lateral knee radiographs. A CT-based image analysis methodology was used to quantify the fracture energy, and agreement between the surgeons' severity rankings and the fracture energy metric was tested by computing their concordance, a statistical measure that estimates the probability that any 2 cases would be ranked with the same ordering by 2 different raters or methods.
  
  
  RESULTS
  Concordance between the 6 orthopaedic surgeons ranged from 82% to 93%, and concordance between surgeon severity rankings and the computed fracture energy ranged from 73% to 78%.
  
  
  CONCLUSIONS
  There is a high level of agreement between experienced surgeons in their assessments of tibial plateau fracture severity, and a slightly lower agreement between the surgeon assessments and an objective CT-based metric of fracture energy. Taken together, these results suggest that experienced surgeons share a similar understanding of what makes a tibial plateau fracture more or less severe, and an objective CT-based metric of fracture energy captures much but not all of that information. Further research is ongoing to characterize the relationship between surgeon assessments of severity, fracture energy, and the eventual clinical outcomes for patients with fractures of the tibial plateau.
authors.affiliation: *Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; †Department of Orthopaedics and Rehabilitation, The University of Iowa, Iowa City, IA; ‡Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, San Francisco, CA; and §Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: Kempton
authors.forename: Kevin
authors.initials: K
authors.lastname: Dibbern
authors.forename: Donald D
authors.initials: DD
authors.lastname: Anderson
authors.forename: Saam
authors.initials: S
authors.lastname: Morshed
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Higgins
authors.forename: J Lawrence
authors.initials: JL
authors.lastname: Marsh
authors.forename: Todd O
authors.initials: TO
authors.lastname: McKinley
mesh_terms: D001696:Biomechanical Phenomena; D006801:Humans; D012720:Severity of Illness Index; D013314:Stress, Mechanical; D013978:Tibial Fractures / Q000145:classification* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed