Importance of radiological studies by means of computed tomography for managing fractures of the tibial plateau

Abstract

ObjectivesTo evaluate the concordance among knee surgery specialists regarding the classification and surgical technique indicated in cases of tibial plateau fracture, using conventional radiographs and computed tomography.MethodsForty-four patients with fractures of the tibial plateau shown on radiographic and tomographic images were selected. These were evaluated by specialists at two different times, with an interval of seven days. On the first occasion, the specialists only had access to the radiographs, while on the second occasion they had access to both radiographs and computed tomography images. Their concordance was evaluated by means of the kappa coefficient.ResultsThe interobserver reliability of the Schatzker classification on the first occasion was 0.36 and on the second occasion, 0.35. This was considered to present low reproducibility. In evaluating the intra-observer reproducibility of this classification, the mean kappa index was 0.42, which was classified as moderate. From evaluating the choice of surgical access, the inter-observer reliability was 0.55 on the first occasion and 0.50 on the second, which was considered to present moderate reproducibility. Evaluation on the implant chosen showed that the interobserver reliability was 0.01 on the first occasion and −0.06 on the second, which was considered to be poor and discordant. In evaluating the classification of the three columns, the inter-observer reproducibility was 0.47 (p < 0.0001), which was classified as moderate concordance.ConclusionUse of computed tomography did not present any improvement in the inter-observer concordance, using the Schatzker classification, and did not produce any change in the preoperative planning.

Reproducibility of Schatzker Classification Through Smartphone Applications

“…Other studies have observed unsatisfactory K indices (near 0.38) in inter-observer analysis 2 , 15 and satisfactory kappa values (0.68) in intra-observer analysis 2 for this classification, which makes clear that the correlation value decreases when the evaluation is between the evaluators. In this study, the concordance results are similar to results obtained in intra-observer analysis for Schatzker classification.…”

Avaliação da reprodutibilidade da classificação de Schatzker revisada por Kfuri para as fraturas do planalto tibial

“…These results are supported by the literature, which presents similar results, with mild to moderate agreement. [6][7][8][9][10]13,[21][22][23][24] Since CT is indispensable for the application of the Kfuri classification, in our study, the evaluators used tomographic and radiographic images to classify by the Schatzker system. The importance of using CT to increase the reliability of the Schatzker classification is still unclear.…”

“…15,21,25,26 A recent study investigated the effect of the addition of 3D tomographic images on the classification of tibial plateau fractures, concluding that the addition of the third dimension did not improve the reproducibility of the system; in fact, the use of 2D images alone had higher agreement. 14 Although the role of CT in the inter-and intraobserver agreement of tibial plateau fractures still needs to be determined, 24 this tool proved to be fundamental in choosing the surgical access route, especially in lesions with coronal orientation. 15,27 Previous studies evaluating tibial plateau fractures reported that the experience of the observers did not influence the degree of reliability of the classifications.…”

“…Tais resultados são suportados pela literatura, que apresenta resultados semelhantes, com concordância de leve a moderada. [6][7][8][9][10]13,[21][22][23][24] Uma vez que a TC é indispensável para a aplicação da classificação de Kfuri, em nosso trabalho, os avaliadores utilizaram as imagens tomográficas e radiográficas para classificar pelo sistema de Schatzker. A importância do uso da TC para aumentar a confiabilidade da classificação de Schatzker ainda não está clara.…”

“…15,21,25,26 Um estudo recente investigou o efeito da adição das imagens tomográficas em 3D na classificação de fraturas do planalto tibial, concluindo que o acréscimo da terceira dimensão não melhorou a reprodutibilidade do sistema; na verdade, o uso das imagens em 2D isoladamente tiveram concordância mais elevada. 14 Apesar do papel da TC na concordância inter-e intraobservador das fraturas do planalto tibial ainda necessitar ser determinado, 24 essa ferramenta mostrouse fundamental na escolha da via de acesso cirúrgico, principalmente nas lesões com orientação no plano coronal. 15,27 Estudos prévios avaliando as fraturas do planalto tibial relataram que a experiência dos observadores não influenciou o grau de confiabilidade das classificações.…”