Classification systems for tibial plateau fractures; does computed tomography scanning improve their reliability?

INTRODUCTION: The purpose of this study was to evaluate the impact of computed tomography scanning on the inter- and intra-observer reliability of the OTA/AO, the Schatzker, and the Hohl classifications in the assessment of tibial plateau fractures.

METHODS: Four independent observers classified 45 consecutive fractures of the tibial plateau according to the criteria of the OTA/AO system, the Schatzker classification, and the Hohl classification. Two sessions of readings were compared; first, the use of plain anterior-posterior and lateral X-rays alone was evaluated, then 4 weeks later the combination of plain X-rays and two-dimensional computed tomography scans were evaluated. The readings were repeated 8 weeks later to evaluate intra-observer reliability.

RESULTS: The three classification systems showed "moderate" inter-observer reliability and "good" and "moderate" intra-observer reliability when classified solely on the basis of plain radiographs. After the addition of computed tomography scans inter-observer reliability significantly improved to "good" in all classifications. Likewise, intra-observer reliability improved to "good" in all classifications after the addition of CT-scans. Statistical analysis showed no significant difference regarding inter- and intra-observer agreement between the three classifications.

CONCLUSIONS: Computed tomography scanning improved the inter- and intra-observer reliability of the OTA/AO, the Schatzker, and the Hohl classification. Overall, all three classification systems showed "good" inter- and intra-observer reproducibility when classified with CT-scans.