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What is the most reproducible classification system to assess tibial plateau fractures?

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Abstract

Purpose

Traditional classification systems for tibial plateau fractures (TPF) are based on simple radiographs, and intra- and inter-observer variability is low. The aim was to assess intra- and inter-observer variability using traditional systems and some recently described classification systems of TPF in the interpretation of standard radiographs and bidimensional (2D) and tridimensional (3D) computed tomography (CT).

Methods

We studied all patients at two centres who underwent TPF surgery over a three-year period. Demographic data (age, sex, BMI) and mechanism of injury were recorded. Four observers classified each TPF according to the Schatzker, AO, Luo, modified Duparc and Khan classification systems. We calculated intra- and inter-observer variability using the Kappa test.

Results

A total of 112 (71 males) patients were included. Mean age was 47.1 years (range 21–86) and mean BMI was 25.2 ± 3.6. Intra- and inter-observer variability was 0.95 and 0.62 for AO, 0.87 and 0.65 for Schaztker, 0.86 and 0.73 for Luo, 0.56 and 0.37 for the modified Duparc, and 0.43 and 0.25 for Khan classifications.

Conclusions

Although previous training could be needed, AO, Schatzker and Luo classifications showed a good reproducibility of TPF assessment from a combination of standard radiographs and 2D and 3D CT images. The results using the Modified Duparc and Khan classifications were less favourable and their use is not therefore recommended.

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Acknowledgements

We are grateful to Iganaci Gich for assisting in the statistical analysis.

This study was awarded Best Podium Presentation at the 53th meeting of the Spanish Society of Orthopaedics Surgery and Traumatology (SECOT) in September 2016.

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Authors and Affiliations

  1. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041, Barcelona, Spain

    Angélica Millán-Billi, Mireia Gómez-Masdeu, Eduard Ramírez-Bermejo, Maximiliano Ibañez & Pablo Eduardo Gelber

  2. ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Sabino de Arana 5-19, 08028, Barcelona, Spain

    Pablo Eduardo Gelber

Authors
  1. Angélica Millán-Billi
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  2. Mireia Gómez-Masdeu
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  3. Eduard Ramírez-Bermejo
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  5. Pablo Eduardo Gelber
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Corresponding author

Correspondence to Pablo Eduardo Gelber.

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On behalf of all authors, the corresponding author states that there are no competing interests.

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Millán-Billi, A., Gómez-Masdeu, M., Ramírez-Bermejo, E. et al. What is the most reproducible classification system to assess tibial plateau fractures?. International Orthopaedics (SICOT) 41, 1251–1256 (2017). https://doi.org/10.1007/s00264-017-3462-x

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  • DOI: https://doi.org/10.1007/s00264-017-3462-x

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