Research output: Contribution to journal › Article › Academic › peer-review
Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures. / Mellema, Jos J.; Doornberg, Job N.; Molenaars, Rik J. et al.
In: Injury, Vol. 47, No. 4, 2016, p. 944-949.Research output: Contribution to journal › Article › Academic › peer-review
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TY - JOUR
T1 - Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures
AU - Mellema, Jos J.
AU - Doornberg, Job N.
AU - Molenaars, Rik J.
AU - Ring, David
AU - Kloen, Peter
AU - AUTHOR GROUP
AU - Babis, George C.
AU - Jeray, Kyle J.
AU - Prayson, Michael J.
AU - Pesantez, Rodrigo
AU - Acacio, Ramos
AU - Verbeek, Diederik O.
AU - Melvanki, Parag
AU - Kreis, Barbara E.
AU - Mehta, Samir
AU - Meylaerts, S.
AU - Wojtek, S.
AU - Yeap, Ewe J.
AU - Haapasalo, Heidi
AU - Kristan, Anže
AU - Coles, Chad
AU - Marsh, J. Lawrence
AU - Mormino, Matthew
AU - Menon, Matthew
AU - Tyllianakis, Minos
AU - Schandelmaier, Peter
AU - Jenkinson, R. J.
AU - Neuhaus, Valentin
AU - Shahriar, Chegini M. H.
AU - Belangero, William D.
AU - Kannan, S. G.
AU - Leonidovich, Golovakha M.
AU - Davenport, J. H.
AU - Kabir, Koroush
AU - Althausen, Peter L.
AU - Weil, Yoram
AU - Toom, Alar
AU - Sa da Costa, Daniel
AU - Lijoi, F.
AU - Koukoulias, Nikolaos E.
AU - Manidakis, Nikolaos
AU - van den Bogaert, Max
AU - Patczai, Balázs
AU - Grauls, Anthony
AU - Kurup, Harish
AU - van den Bekerom, Michel P.
AU - Lansdaal, Joris R.
AU - Vale, M.ário
AU - Ousema, Paul
AU - Haverkamp, Daniel
AU - Schepers, T.
PY - 2016
Y1 - 2016
N2 - Tibial plateau fracture classification systems have limited interobserver reliability and new systems emerge. The purpose of this study was to compare the reliability of the Luo classification and the Schatzker classification for two-dimensional computed tomography (2DCT) and to study the effect of adding three-dimensional computed tomography (3DCT). Eighty-one observers, orthopedic surgeons and residents, were randomized to either 2DCT or 2D- and 3DCT evaluation of a spectrum of 15 complex tibial plateau fractures using web-based platforms in order to classify according to the Schatzker and according to Luo's Three Column classification. Reliability was calculated with the use of Siegel and Castellan's multirater kappa measure. Kappa values were interpreted according to the categorical rating by Landis and Koch. Overall interobserver reliability of the Schatzker classification was significantly better compared to the Luo classification (kSchatzker=0.32 and kLuo=0.28, P=0.021), however, 'fair' for both fracture classification systems. For the Schatzker classification observers agreed significantly better on 2DCT compared to 2D- and 3DCT (k2DCT=0.37 and k2D+3DCT=0.29, P <0.001). The addition of 3DCT did not improve the overall interobserver reliability for the Luo classification as well, as kappa values were not significantly different on 2DCT and 2D- and 3DCT (k2DCT=0.31 and k2D+3DCT=0.25, P=0.096). The agreement between observers was significantly better for the Schatzker classification compared to Luo's Three Column classification, however agreement was fair for both classification systems. Furthermore, the addition of 3DCT reconstructions did not improve the reliability of CT-based evaluation of tibial plateau fractures. Considering that new classification systems and 3DCT do not seem to improve agreement between surgeons, other efforts are needed that lead to more reliable diagnosis of complex tibial plateau fractures
AB - Tibial plateau fracture classification systems have limited interobserver reliability and new systems emerge. The purpose of this study was to compare the reliability of the Luo classification and the Schatzker classification for two-dimensional computed tomography (2DCT) and to study the effect of adding three-dimensional computed tomography (3DCT). Eighty-one observers, orthopedic surgeons and residents, were randomized to either 2DCT or 2D- and 3DCT evaluation of a spectrum of 15 complex tibial plateau fractures using web-based platforms in order to classify according to the Schatzker and according to Luo's Three Column classification. Reliability was calculated with the use of Siegel and Castellan's multirater kappa measure. Kappa values were interpreted according to the categorical rating by Landis and Koch. Overall interobserver reliability of the Schatzker classification was significantly better compared to the Luo classification (kSchatzker=0.32 and kLuo=0.28, P=0.021), however, 'fair' for both fracture classification systems. For the Schatzker classification observers agreed significantly better on 2DCT compared to 2D- and 3DCT (k2DCT=0.37 and k2D+3DCT=0.29, P <0.001). The addition of 3DCT did not improve the overall interobserver reliability for the Luo classification as well, as kappa values were not significantly different on 2DCT and 2D- and 3DCT (k2DCT=0.31 and k2D+3DCT=0.25, P=0.096). The agreement between observers was significantly better for the Schatzker classification compared to Luo's Three Column classification, however agreement was fair for both classification systems. Furthermore, the addition of 3DCT reconstructions did not improve the reliability of CT-based evaluation of tibial plateau fractures. Considering that new classification systems and 3DCT do not seem to improve agreement between surgeons, other efforts are needed that lead to more reliable diagnosis of complex tibial plateau fractures
U2 - 10.1016/j.injury.2015.12.022
DO - 10.1016/j.injury.2015.12.022
M3 - Article
C2 - 26777468
VL - 47
SP - 944
EP - 949
JO - Injury
JF - Injury
SN - 0020-1383
IS - 4
ER -
ID: 2815719