The value of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures

Abstract

This study aimed to evaluate the intra- and interobserver agreement for both fracture classification according to Schatzker and treatment plan of tibial plateau fractures using plain radiographs alone and with computed tomography (CT) scans. The study was carried out prospectively to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures. Eight experienced observers (six surgeons and two radiologists) classified 15 tibial plateau fractures with plain radiographs and CT scans and set up a treatment plan. Agreement was measured using kappa coefficients. Using plain radiographs alone, the mean interobserver kappa coefficient for classification was 0.47, which decreased to 0.46 after addition of CT scans. Using plain films alone for formulating a treatment plan, the mean interobserver kappa coefficient was 0.40, which decreased to 0.30 after addition of CT scans. The mean intraobserver kappa coefficient for fracture classification using plain radiographs was 0.60, which decreased to 0.57 with addition of CT scans. The mean intraobserver kappa coefficient for treatment plan based on plain radiographs alone was 0.53, which decreased to 0.45 after addition of CT scans. In contrast with other recent publications, there is no increase in inter- and intra-agreement of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures. Routine CT scanning of the knee for tibial plateau fractures is not supported by this study.

Intraobserver and interobserver reliability assessment of tibial plateau fracture classification systems

“…Our study yielded comparable interobserver (κ XR =0.51; κ CT =0.61) and intraobserver (κ XR = 0.58; κ CT =0.66) results to those of Brunner et al [10] (κ XR =0.418; κ CT =0.755). This was slightly better than the quoted mean κ CT of 0.61 from several other studies [8,11,12] but worse than findings of Brunner et al [10] and Hu et al [13] The clinical experience has been suggested to affect the interobserver reliability between observers with different level of experience; [10,14] however, our study findings contradicted with this, with no significant differences found among the observers despite differences in experience.…”

Inter-observer reliability assessment of the Schatzker, AO/OTA and three-column classification of tibial plateau fractures

“…Recently, several studies concluded that a multiplanar CT scan enhances the reliability in classifying tibial plateau fractures [9-12]. Compared to the conventional AO and Schatzker classification, a CT-based three-column classification as applied in our study is associated with substantial agreement amongst independent observers [8].…”

Greater Tuberosity Fractures: Does Fracture Assessment and Treatment Recommendation Vary Based on Imaging Modality?

“…Previous studies of other anatomic areas are conflicting when comparing interobserver agreement among imaging modalities [5,22]. For example, Brunner et al [5] found higher reliability of tibia plateau fracture classification on CT images with radiographs compared with radiographs alone, whereas te Stroet et al [22] did not find a difference in reliability for classification and treatment recommendation between CT images and radiographs for these fractures. This discrepancy might be explained by the relatively low number of observers, inclusion of different fracture subtypes, and difference in quality of the imaging.…”

“…Studies of fractures at other anatomic areas (such as the tibia plateau) are conflicting regarding improved fracture assessment reliability when comparing CT scans with radiographs [5,6,22]. Criteria used for diagnosis or treatment ideally should be reliable, accurate, and associated with outcome.…”