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A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Objectives

Variable angle locking compression plates allow for lateral buttress and support of the posterolateral joint surface of tibial plateau fractures. This gives room for improvement of the surgical 3-column classification approach. Our aim was to revise and validate the 3-column classification approach to better guide the surgical planning of tibial plateau fractures extending into the posterolateral corner.

Methods

In contrast to the 3-column classification approach, in the revised approach the posterior border of the lateral column in the revised approach lies posterior instead of anterior of the fibula. According to the revised 3-column classification approach, extended lateral column fractures are defined as single lateral column fractures extending posteriorly into the posterolateral corner. CT-images of 36 patients were reviewed and classified twice online according to Schatzker and revised 3-column classification approach by five observers. The intraobserver reliability was calculated using the Cohen’s kappa and the interobserver reliability was calculated using the Fleiss’ kappa.

Results

The intraobserver reliability showed substantial agreement according to Landis and Koch for both Schatzker and the revised 3-column classification approach (0.746 vs. 0.782 p = 0.37, Schatzker vs. revised 3-column, respectively). However, the interobserver reliability of the revised 3-column classification approach was significantly higher as compared to the Schatzker classification (0.531 vs. 0.669 p < 0.01, moderate vs. substantial agreement, Schatzker vs. revised 3-column, respectively).

Conclusions

With the introduction of variable angle locking compression plates, the revised 3-column classification approach is a very helpful tool in the preoperative surgical planning of tibial plateau fractures, in particular, lateral column fractures that extend into the posterolateral corner. The revised 3-column classification approach is rather a practical supplement to the Schatzker classification. It has a significantly higher interobserver reliability as compared to the Schatzker classification, most likely due to the more simple nature of the revised 3-column classification approach.

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Acknowledgments

Observer Raul Mayr MD, Department of Trauma Surgery, Medical University Innsbruck, Austria (Chairman: Blauth Prof. MD); Observer Norbert Südkamp Prof. MD, Medical Director, Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Germany; Observer Andrea Migliorini MD, Department of Orthopedic Surgery and Traumatology, Cavalese Hospital, Trento, Italy; Observer Yukai Wang MD, Trauma Service III (Chairman: Cong-Feng Luo Prof. MD), Department of Orthopedic Traumatology, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, China; Observer Martijn Hofman MD, Department of Orthopaedic Trauma, University Hospital RWTH Aachen, Germany (Chairman: Hans-Christoph Pape Prof. MD); We thank Dennis Devriendt for setting up the online platform for our observers to assess the CT- images.

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Authors and Affiliations

  1. Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium

    H. Hoekstra & S. Nijs

  2. Department of Development and Regeneration, KU Leuven, University of Leuven, 3000, Louvain, Belgium

    H. Hoekstra & S. Nijs

  3. Faculty of Medicine, KU Leuven, University of Leuven, 3000, Louvain, Belgium

    K. Kempenaers

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  1. H. Hoekstra
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Correspondence to H. Hoekstra.

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This study was conducted in compliance with national legislation and the guidelines of the ethics committee of the University Hospitals Leuven.

Conflict of interest

Harm Hoekstra, Kristof Kempenaers and Stefaan Nijs declare that they have no conflict of interest.

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Hoekstra, H., Kempenaers, K. & Nijs, S. A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures. Eur J Trauma Emerg Surg 43, 637–643 (2017). https://doi.org/10.1007/s00068-016-0696-z

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