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Three-column classification and Schatzker classification: a three- and two-dimensional computed tomography characterisation and analysis of tibial plateau fractures

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

The aim of the study was to evaluate inter-observer reliability and intra-observer reproducibility between the three-column classification and Schatzker classification systems using 2D and 3D CT models.

Materials and methods

Fifty-two consecutive patients with tibial plateau fractures were evaluated by five orthopaedic surgeons. All patients were classified into Schatzker and three-column classification systems using x-rays and 2D and 3D CT images. The inter-observer reliability was evaluated in the first round and the intra-observer reliability was determined during the second round 2 weeks later.

Results

The average intra-observer reproducibility for the three-column classification was from substantial to excellent in all sub classifications, as compared with Schatzker classification. The inter-observer kappa values increased from substantial to excellent in three-column classification and to moderate in Schatzker classification The average values for three-column classification for all the categories are as follows: (I–III) k2D = 0.718, 95 % CI 0.554–0.864, p < 0.0001 and average 3D = 0.874, 95 % CI 0.754–0.890, p < 0.0001. For Schatzker classification system, the average values for all six categories are as follows: (I–VI) k2D = 0.536, 95 % CI 0.365–0.685, p < 0.0001 and average k3D = 0.552 95 % CI 0.405–0.700, p < 0.0001. The values are statistically significant.

Conclusion

Statistically significant inter-observer values in both rounds were noted with the three-column classification, making it statistically an excellent agreement. The intra-observer reproducibility for the three-column classification improved as compared with the Schatzker classification. The three-column classification seems to be an effective way to characterise and classify fractures of tibial plateau.

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Authors and Affiliations

  1. Department of Orthopaedics, University Hospital of Wales, 84 Colchester Avenue Penylan, Cardiff, UK

    Sheethal Prasad Patange Subba Rao, James Lewis, Vishal Paringe & Khitish Mohanty

  2. Jersey General Hospitals, Jersey, UK

    Ziad Haddad

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  1. Sheethal Prasad Patange Subba Rao
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  2. James Lewis
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  3. Ziad Haddad
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  4. Vishal Paringe
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  5. Khitish Mohanty
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Correspondence to Sheethal Prasad Patange Subba Rao.

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Patange Subba Rao, S.P., Lewis, J., Haddad, Z. et al. Three-column classification and Schatzker classification: a three- and two-dimensional computed tomography characterisation and analysis of tibial plateau fractures. Eur J Orthop Surg Traumatol 24, 1263–1270 (2014). https://doi.org/10.1007/s00590-013-1308-9

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