Interobserver Reliability of Schatzker, AO Foundation-Orthopaedic Trauma Association, and Luo Classifications for Tibial Plateau Fractures: Does Three-Dimensional CT Improve Outcomes?

Masouros, Panagiotis; Mitrogiannis, George; Antoniou, Georgia; Chatzidaki, Christina; Kourtzis, Dimitrios; Garnavos, Christos

doi:10.7759/cureus.22227

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Unfortunately, similar to the previous mentioned studies, no additional information on significance was provided. The studies of Gicquel et al [ 28 ] and Masouros et al [ 29 ] did provide a 95% confidence interval, although, no significant changes in interobserver agreement were described. A substantial agreement was the highest achieved interobserver agreement for 2D CT and was achieved in the study of Brunner et al [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

The effect of addition of 2DCT scans and 3DCT scans for the classification of tibial plateau fractures: a systematic review

Huitema,

van der Gaast,

Jaarsma

et al. 2023

Eur J Trauma Emerg Surg

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Purpose In this systematic review, we evaluate the effect of radiographs and 2D and 3D imaging techniques on the interobserver agreement of six commonly used classification systems for tibial plateau fractures. Methods In accordance with PRISMA guidelines, PubMed, Cochrane, Embase and Web of Science were searched for studies regarding the effect of 2D and 3D imaging techniques on the interobserver agreement of tibial plateau classification systems. Studies validating new classification systems, not providing own data or only providing information on the interobserver agreement for radiographs were excluded. Studies were scored based on the ROBINS-I risk of bias tool. Results Our review analysed 14 studies on different classification systems used for tibial plateau fractures in clinical practice, with the Schatzker classification being the most commonly used classification system. The results showed that the addition of 2D CT led to a significant improvement of interobserver agreement for one study. However, other included studies showed varying levels of interobserver agreement, ranging from fair to substantial according to the interpretation by Landis and Koch. The addition of 3D CT resulted in a significant deterioration in one study for the Schatzker classification. Similar to the addition of 2D CT, the interobserver agreement for the Schatzker classification with the addition of 3D CT were heterogeneous ranging from fair to almost perfect according to the interpretation by Landis and Koch. Conclusions The use of 2D CT can be recommended for classifying tibial plateau fractures with the Schatzker classification, AO/OTA classification and Hohl classification. The value of 3D CT on the interobserver agreement of commonly used classification systems remains uncertain and unproven. Therefore, we do not recommend the use of 3D CT for the classification of tibial plateau fractures. Overall, the advancement of imaging techniques is not in line with the advancement in interobserver agreement on fracture classification.

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Section: Resultsmentioning

confidence: 99%

The effect of addition of 2DCT scans and 3DCT scans for the classification of tibial plateau fractures: a systematic review

Huitema,

van der Gaast,

Jaarsma

et al. 2023

Eur J Trauma Emerg Surg

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“…Despite its limitations, the current study has several strengths. Adequate preoperative imaging was available for all patients, and inter-observer reliability for fracture classification was greater than previously reported in the literature [26,27]. This study also included a mean of nearly 4 years of follow up, patient-reported outcomes, and activity levels.…”

Section: Discussionmentioning

confidence: 99%

Tibial Plateau Fractures among Alpine Skiers: A Retrospective Case Series

Williamson¹,

Smith²,

Swanson³

et al. 2023

Osteology

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The purpose of this retrospective case series was to review the demographics of alpine skiers who sustain tibial plateau fractures, evaluate the inter-observer reliability of the Schatzker classification for fractures sustained while alpine skiing, and to evaluate patient-reported outcomes. We hypothesized that most tibial plateau fractures would be low-energy fracture patterns (Schatzker I–III) and occur in women and less-experienced skiers. Charts and radiographs of patients treated surgically for tibial plateau fractures caused by alpine skiing were evaluated. Patients treated less than two years prior to review were excluded. Patients who qualified were contacted to complete a questionnaire regarding their skiing experience, their pain levels experienced following their accident, the weather conditions during the accident, and their return to sport. Forty-seven patients met the inclusion criteria. The mean age was 49, and 60% of the participants were male. There were 28 low-energy fracture patterns (Schatzker I–III) and 19 high-energy patterns (Schatzker IV–VI) with a 95.7% inter-observer reliability. Contrary to the hypothesis, tibial plateau fractures sustained while alpine skiing occurred in older, experienced riders. Approximately 40% were high-energy fractures. Although over 75% of patients reported having no pain or occasional pain at their final follow-ups, less than half of the patients returned to alpine skiing.

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Comparison of virtual reality and computed tomography in the preoperative planning of complex tibial plateau fractures

Colcuc,

Miersbach,

Cienfuegos

et al. 2024

Arch Orthop Trauma Surg

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Introduction Preoperative planning is a critical step in the success of any complex surgery. The pur-pose of this study is to evaluate the advantage of VR glasses in surgical planning of complex tibial plateau fractures compared to CT planning. Materials and methods Five orthopedic surgeons performed preoperative planning for 30 fractures using either conventional CT slices or VR visualization with a VR headset. Planning was performed in a randomized order with a 3-month interval between planning sessions. A standardized questionnaire assessed planned operative time, planning time, fracture classification and understanding, and surgeons’ subjective confidence in surgical planning. Results The mean planned operative time of 156 (SD 47) minutes was significantly lower (p < 0.001) in the VR group than in the CT group (172 min; SD 44). The mean planning time in the VR group was 3.48 min (SD 2.4), 17% longer than in the CT group (2.98 min, SD 1.9; p = 0.027). Relevant parameters influencing planning time were surgeon experience (-0.61 min) and estimated complexity of fracture treatment (+ 0.65 min). Conclusion The use of virtual reality for surgical planning of complex tibial plateau fractures resulted in significantly shorter planned operative time, while planning time was longer compared to CT planning. After VR planning, more surgeons felt (very) well prepared for surgery.

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Interobserver Reliability of Schatzker, AO Foundation-Orthopaedic Trauma Association, and Luo Classifications for Tibial Plateau Fractures: Does Three-Dimensional CT Improve Outcomes?

Cited by 3 publications

References 18 publications

The effect of addition of 2DCT scans and 3DCT scans for the classification of tibial plateau fractures: a systematic review

The effect of addition of 2DCT scans and 3DCT scans for the classification of tibial plateau fractures: a systematic review

Tibial Plateau Fractures among Alpine Skiers: A Retrospective Case Series

Comparison of virtual reality and computed tomography in the preoperative planning of complex tibial plateau fractures

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