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

Rao, Sheethal Prasad Patange Subba; Lewis, James H.; Haddad, Ziad S.; Paringe, V.; Mohanty, Khitish

doi:10.1007/s00590-013-1308-9

Cited by 22 publications

(4 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The primary limitation of this study is that the injury mechanism of TPFs was ascertained from fracture morphology on the basis of our clinical experience and previous biomechanical studies. 5,17,38 Although attempts have been made, 20 it is difficult to simulate the injury mechanism of TPFs in various specimens using existing experimental conditions, whether quantitative analysis or even qualitative description. In addition, in a clinical setting, it is critically important to recognize the concurrent soft-tissue injuries in TPFs 29 as they may require different approaches and treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept

Zhang

Sun

Zhan

et al. 2019

Bone & Joint Research

View full text Add to dashboard Cite

Objectives CT-based three-column classification (TCC) has been widely used in the treatment of tibial plateau fractures (TPFs). In its updated version (updated three-column concept, uTCC), a fracture morphology-based injury mechanism was proposed for effective treatment guidance. In this study, the injury mechanism of TPFs is further explained, and its inter- and intraobserver reliability is evaluated to perfect the uTCC. Methods The radiological images of 90 consecutive TPF patients were collected. A total of 47 men (52.2%) and 43 women (47.8%) with a mean age of 49.8 years (sd 12.4; 17 to 77) were enrolled in our study. Among them, 57 fractures were on the left side (63.3%) and 33 were on the right side (36.7%); no bilateral fracture existed. Four observers were chosen to classify or estimate independently these randomized cases according to the Schatzker classification, TCC, and injury mechanism. With two rounds of evaluation, the kappa values were calculated to estimate the inter- and intrareliability. Results The overall inter- and intraobserver agreements of the injury mechanism were substantial (κinter = 0.699, κintra = 0.749, respectively). The initial position and the force direction, which are two components of the injury mechanism, had substantial agreement for both inter-reliability or intrareliability. The inter- and intraobserver agreements were lower in high-energy fractures (Schatzker types IV to VI; κinter = 0.605, κintra = 0.721) compared with low-energy fractures (Schatzker types I to III; κinter = 0.81, κintra = 0.832). The inter- and intraobserver agreements were relatively higher in one-column fractures (κinter = 0.759, κintra = 0.801) compared with two-column and three-column fractures. Conclusion The complete theory of injury mechanism of TPFs was first put forward to make the TCC consummate. It demonstrates substantial inter- and intraobserver agreement generally. Furthermore, the injury mechanism can be promoted clinically. Cite this article: B-B. Zhang, H. Sun, Y. Zhan, Q-F. He, Y. Zhu, Y-K. Wang, C-F. Luo. Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept. Bone Joint Res 2019;8:357–366. DOI: 10.1302/2046-3758.88.BJR-2018-0331.R1.

show abstract

Section: Discussionmentioning

confidence: 99%

Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept

Zhang

Sun

Zhan

et al. 2019

Bone & Joint Research

View full text Add to dashboard Cite

show abstract

“…Moreover, van den Berg et al [ 31 ] compared 2D CT with 3D CT solely and showed a deterioration in interobserver agreement after addition of 3D CT, they did not provide information on significance. Doornberg et al [ 32 ] and Patange et al [ 33 ] compared radiographs and 2D CT to the combination of 3D CT, 2D CT and radiographs, but both studies showed no significant differences. Castiglia et al [ 24 ] compared radiographs with the combination of radiographs, 2D CT and 3D CT and showed a small, categorical improvement in interobserver agreement; however, no information on significance was given.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…The three-column system of classification improves upon the initial radiograph-based systems of classification by more effectively accounting for posterior fractures with a high-level of intraobserver and interobserver agreement. 44,45 A ten-segment classification system developed by Krause et al 46 takes the CT model of the three-column method further, classifying the tibial plateau into ten segments. The ten-segment model provides more information about specific fracture locations, but there is no evidence that it maintains the same level of interobserver reliability as the three-column classification or improves treatment plans and outcomes.…”

Section: Classificationmentioning

confidence: 99%

“…A pure articular depression fracture is defined as a zero-column fracture. The three-column system of classification improves upon the initial radiograph-based systems of classification by more effectively accounting for posterior fractures with a high-level of intraobserver and interobserver agreement 44,45. A ten-segment classification system developed by Krause et al 46.…”

Section: Classificationmentioning

confidence: 99%

Management of unicondylar tibial plateau fractures: a review

Warren

Domingue²,

Riehl

2021

Current Orthopaedic Practice

View full text Add to dashboard Cite

Unicondylar tibial plateau fracture (TPF) is a common orthopaedic injury. Although some are treated nonsurgically with excellent results, many are treated operatively to achieve improved patient outcomes. Commonly utilized surgical treatment options include open reduction internal fixation (ORIF) and percutaneous treatment which may include arthroscopic reduction internal fixation (ARIF). The most used classification remains the Schatzker fracture classification. This article presents a review of the epidemiology, relevant anatomy, biomechanics, clinical presentation, diagnosis, and management of tibial plateau fractures.

show abstract

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

Cited by 22 publications

References 32 publications

Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept

Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept

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

Management of unicondylar tibial plateau fractures: a review

Contact Info

Product

Resources

About