title: What is the most reproducible classification system to assess tibial plateau fractures?
abstract: Traditional classification systems for tibial plateau fractures (TPF) are based on simple radiographs, and intra- and inter-observer variability is low. The aim was to assess intra- and inter-observer variability using traditional systems and some recently described classification systems of TPF in the interpretation of standard radiographs and bidimensional (2D) and tridimensional (3D) computed tomography (CT).
  
  
  
  We studied all patients at two centres who underwent TPF surgery over a three-year period. Demographic data (age, sex, BMI) and mechanism of injury were recorded. Four observers classified each TPF according to the Schatzker, AO, Luo, modified Duparc and Khan classification systems. We calculated intra- and inter-observer variability using the Kappa test.
  
  
  
  A total of 112 (71 males) patients were included. Mean age was 47.1 years (range 21-86) and mean BMI was 25.2 ± 3.6. Intra- and inter-observer variability was 0.95 and 0.62 for AO, 0.87 and 0.65 for Schaztker, 0.86 and 0.73 for Luo, 0.56 and 0.37 for the modified Duparc, and 0.43 and 0.25 for Khan classifications.
  
  
  
  Although previous training could be needed, AO, Schatzker and Luo classifications showed a good reproducibility of TPF assessment from a combination of standard radiographs and 2D and 3D CT images. The results using the Modified Duparc and Khan classifications were less favourable and their use is not therefore recommended.
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041, Barcelona, Spain.
authors.forename: Angélica
authors.initials: A
authors.lastname: Millán-Billi
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041, Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Gómez-Masdeu
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041, Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Ramírez-Bermejo
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041, Barcelona, Spain.
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Ibañez
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041, Barcelona, Spain. personal@drgelber.com.|ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Sabino de Arana 5-19, 08028, Barcelona, Spain. personal@drgelber.com.
authors.forename: Pablo Eduardo
authors.initials: PE
authors.lastname: Gelber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords: Fracture classification; Interobserver; Tibial plateau