Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures

J.J. Mellema; J.N. Doornberg; R.J. Molenaars; D. Ring; P. Kloen; G.C. Babis; K.J. Jeray; M.J. Prayson; R. Pesantez; R. Acacio; D.O. Verbeek; P. Melvanki; B.E. Kreis; S. Mehta; S. Meylaerts; S. Wojtek; E.J. Yeap; H. Haapasalo; A. Kristan; C. Coles; J.L. Marsh; M. Mormino; M. Menon; M. Tyllianakis; P. Schandelmaier; R.J. Jenkinson; V. Neuhaus; C.M.H. Shahriar; W.D. Belangero; S.G. Kannan; G.M. Leonidovich; J.H. Davenport; K. Kabir; P.L. Althausen; Y. Weil; A. Toom; D. Sa Da Costa; F. Lijoi; N.E. Koukoulias; N. Manidakis; M. Van Den Bogaert; B. Patczai; A. Grauls; H. Kurup; M.P. Van Den Bekerom; J.R. Lansdaal; M. Vale; P. Ousema; A. Barquet; B.J. Cross; H. Broekhuyse; D. Haverkamp; M. Merchant; E. Harvey; E. Stojkovska Pemovska; F. Frihagen; F.J. Seibert; C. Garnavos; H. Van Der Heide; H.A. Villamizar; I. Harris; L.C. Borris; O. Brink; P.R.G. Brink; P. Choudhari; M. Swiontkowski; T. Mittlmeier; T. Tosounidis; I. Van Rensen; N. Martinelli; D.H. Park; N. Lasanianos; J. Vide; A. Engvall; R.D. Zura; A. Jubel; A. Kawaguchi; H. Goost; J. Bishop; L. Mica; M. Pirpiris; S.H. Van Helden; S. Bouaicha; T. Schepers; T. Havliček; V. Giordano

doi:10.1016/j.injury.2015.12.022

Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures

J.J. Mellema, J.N. Doornberg, R.J. Molenaars, D. Ring, P. Kloen, G.C. Babis, K.J. Jeray, M.J. Prayson, R. Pesantez, R. Acacio, D.O. Verbeek, P. Melvanki, B.E. Kreis, S. Mehta, S. Meylaerts, S. Wojtek, E.J. Yeap, H. Haapasalo, A. Kristan, C. ColesJ.L. Marsh, M. Mormino, M. Menon, M. Tyllianakis, P. Schandelmaier, R.J. Jenkinson, V. Neuhaus, C.M.H. Shahriar, W.D. Belangero, S.G. Kannan, G.M. Leonidovich, J.H. Davenport, K. Kabir, P.L. Althausen, Y. Weil, A. Toom, D. Sa Da Costa, F. Lijoi, N.E. Koukoulias, N. Manidakis, M. Van Den Bogaert, B. Patczai, A. Grauls, H. Kurup, M.P. Van Den Bekerom, J.R. Lansdaal, M. Vale, P. Ousema, A. Barquet, B.J. Cross, H. Broekhuyse, D. Haverkamp, M. Merchant, E. Harvey, E. Stojkovska Pemovska, F. Frihagen, F.J. Seibert, C. Garnavos, H. Van Der Heide, H.A. Villamizar, I. Harris, L.C. Borris, O. Brink, P.R.G. Brink, P. Choudhari, M. Swiontkowski, T. Mittlmeier, T. Tosounidis, I. Van Rensen, N. Martinelli, D.H. Park, N. Lasanianos, J. Vide, A. Engvall, R.D. Zura, A. Jubel, A. Kawaguchi, H. Goost, J. Bishop, L. Mica, M. Pirpiris, S.H. Van Helden, S. Bouaicha, T. Schepers, T. Havliček, V. Giordano

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Abstract

© 2016 Elsevier Ltd.Introduction Tibial plateau fracture classification systems have limited interobserver reliability and new systems emerge. The purpose of this study was to compare the reliability of the Luo classification and the Schatzker classification for two-dimensional computed tomography (2DCT) and to study the effect of adding three-dimensional computed tomography (3DCT). Materials and Methods Eighty-one observers, orthopedic surgeons and residents, were randomized to either 2DCT or 2D- and 3DCT evaluation of a spectrum of 15 complex tibial plateau fractures using web-based platforms in order to classify according to the Schatzker and according to Luo's Three Column classification. Reliability was calculated with the use of Siegel and Castellan's multirater kappa measure. Kappa values were interpreted according to the categorical rating by Landis and Koch. Results Overall interobserver reliability of the Schatzker classification was significantly better compared to the Luo classification (kSchatzker = 0.32 and kLuo = 0.28, P = 0.021), however, 'fair' for both fracture classification systems. For the Schatzker classification observers agreed significantly better on 2DCT compared to 2D- and 3DCT (k2DCT = 0.37 and k2D+3DCT = 0.29, P < 0.001). The addition of 3DCT did not improve the overall interobserver reliability for the Luo classification as well, as kappa values were not significantly different on 2DCT and 2D- and 3DCT (k2DCT = 0.31 and k2D+3DCT = 0.25, P = 0.096). Conclusions The agreement between observers was significantly better for the Schatzker classification compared to Luo's Three Column classification, however agreement was fair for both classification systems. Furthermore, the addition of 3DCT reconstructions did not improve the reliability of CT-based evaluation of tibial plateau fractures. Considering that new classification systems and 3DCT do not seem to improve agreement between surgeons, other efforts are needed that lead to more reliable diagnosis of complex tibial plateau fractures.

Original language	English
Pages (from-to)	944-949
Journal	Injury
Volume	47
Issue number	4
DOIs	https://doi.org/10.1016/j.injury.2015.12.022
Publication status	Published - 1 Apr 2016
Externally published	Yes

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Mellema, J. J., Doornberg, J. N., Molenaars, R. J., Ring, D., Kloen, P., Babis, G. C., Jeray, K. J., Prayson, M. J., Pesantez, R., Acacio, R., Verbeek, D. O., Melvanki, P., Kreis, B. E., Mehta, S., Meylaerts, S., Wojtek, S., Yeap, E. J., Haapasalo, H., Kristan, A., ... Giordano, V. (2016). Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures. Injury, 47(4), 944-949. https://doi.org/10.1016/j.injury.2015.12.022

@article{eeae4ccb6f014ca89388aa9bbc6bc90e,

title = "Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures",

abstract = "{\textcopyright} 2016 Elsevier Ltd.Introduction Tibial plateau fracture classification systems have limited interobserver reliability and new systems emerge. The purpose of this study was to compare the reliability of the Luo classification and the Schatzker classification for two-dimensional computed tomography (2DCT) and to study the effect of adding three-dimensional computed tomography (3DCT). Materials and Methods Eighty-one observers, orthopedic surgeons and residents, were randomized to either 2DCT or 2D- and 3DCT evaluation of a spectrum of 15 complex tibial plateau fractures using web-based platforms in order to classify according to the Schatzker and according to Luo's Three Column classification. Reliability was calculated with the use of Siegel and Castellan's multirater kappa measure. Kappa values were interpreted according to the categorical rating by Landis and Koch. Results Overall interobserver reliability of the Schatzker classification was significantly better compared to the Luo classification (kSchatzker = 0.32 and kLuo = 0.28, P = 0.021), however, 'fair' for both fracture classification systems. For the Schatzker classification observers agreed significantly better on 2DCT compared to 2D- and 3DCT (k2DCT = 0.37 and k2D+3DCT = 0.29, P < 0.001). The addition of 3DCT did not improve the overall interobserver reliability for the Luo classification as well, as kappa values were not significantly different on 2DCT and 2D- and 3DCT (k2DCT = 0.31 and k2D+3DCT = 0.25, P = 0.096). Conclusions The agreement between observers was significantly better for the Schatzker classification compared to Luo's Three Column classification, however agreement was fair for both classification systems. Furthermore, the addition of 3DCT reconstructions did not improve the reliability of CT-based evaluation of tibial plateau fractures. Considering that new classification systems and 3DCT do not seem to improve agreement between surgeons, other efforts are needed that lead to more reliable diagnosis of complex tibial plateau fractures.",

author = "J.J. Mellema and J.N. Doornberg and R.J. Molenaars and D. Ring and P. Kloen and G.C. Babis and K.J. Jeray and M.J. Prayson and R. Pesantez and R. Acacio and D.O. Verbeek and P. Melvanki and B.E. Kreis and S. Mehta and S. Meylaerts and S. Wojtek and E.J. Yeap and H. Haapasalo and A. Kristan and C. Coles and J.L. Marsh and M. Mormino and M. Menon and M. Tyllianakis and P. Schandelmaier and R.J. Jenkinson and V. Neuhaus and C.M.H. Shahriar and W.D. Belangero and S.G. Kannan and G.M. Leonidovich and J.H. Davenport and K. Kabir and P.L. Althausen and Y. Weil and A. Toom and {Sa Da Costa}, D. and F. Lijoi and N.E. Koukoulias and N. Manidakis and {Van Den Bogaert}, M. and B. Patczai and A. Grauls and H. Kurup and {Van Den Bekerom}, M.P. and J.R. Lansdaal and M. Vale and P. Ousema and A. Barquet and B.J. Cross and H. Broekhuyse and D. Haverkamp and M. Merchant and E. Harvey and {Stojkovska Pemovska}, E. and F. Frihagen and F.J. Seibert and C. Garnavos and {Van Der Heide}, H. and H.A. Villamizar and I. Harris and L.C. Borris and O. Brink and P.R.G. Brink and P. Choudhari and M. Swiontkowski and T. Mittlmeier and T. Tosounidis and {Van Rensen}, I. and N. Martinelli and D.H. Park and N. Lasanianos and J. Vide and A. Engvall and R.D. Zura and A. Jubel and A. Kawaguchi and H. Goost and J. Bishop and L. Mica and M. Pirpiris and {Van Helden}, S.H. and S. Bouaicha and T. Schepers and T. Havli{\v c}ek and V. Giordano",

year = "2016",

month = apr,

day = "1",

doi = "10.1016/j.injury.2015.12.022",

language = "English",

volume = "47",

pages = "944--949",

journal = "Injury",

issn = "0020-1383",

publisher = "Elsevier Limited",

number = "4",

}

Mellema, JJ, Doornberg, JN, Molenaars, RJ, Ring, D, Kloen, P, Babis, GC, Jeray, KJ, Prayson, MJ, Pesantez, R, Acacio, R, Verbeek, DO, Melvanki, P, Kreis, BE, Mehta, S, Meylaerts, S, Wojtek, S, Yeap, EJ, Haapasalo, H, Kristan, A, Coles, C, Marsh, JL, Mormino, M, Menon, M, Tyllianakis, M, Schandelmaier, P, Jenkinson, RJ, Neuhaus, V, Shahriar, CMH, Belangero, WD, Kannan, SG, Leonidovich, GM, Davenport, JH, Kabir, K, Althausen, PL, Weil, Y, Toom, A, Sa Da Costa, D, Lijoi, F, Koukoulias, NE, Manidakis, N, Van Den Bogaert, M, Patczai, B, Grauls, A, Kurup, H, Van Den Bekerom, MP, Lansdaal, JR, Vale, M, Ousema, P, Barquet, A, Cross, BJ, Broekhuyse, H, Haverkamp, D, Merchant, M, Harvey, E, Stojkovska Pemovska, E, Frihagen, F, Seibert, FJ, Garnavos, C, Van Der Heide, H, Villamizar, HA, Harris, I, Borris, LC, Brink, O, Brink, PRG, Choudhari, P, Swiontkowski, M, Mittlmeier, T, Tosounidis, T, Van Rensen, I, Martinelli, N, Park, DH, Lasanianos, N, Vide, J, Engvall, A, Zura, RD, Jubel, A, Kawaguchi, A, Goost, H, Bishop, J, Mica, L, Pirpiris, M, Van Helden, SH, Bouaicha, S, Schepers, T, Havliček, T & Giordano, V 2016, 'Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures', Injury, vol. 47, no. 4, pp. 944-949. https://doi.org/10.1016/j.injury.2015.12.022

TY - JOUR

T1 - Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures

AU - Mellema, J.J.

AU - Doornberg, J.N.

AU - Molenaars, R.J.

AU - Ring, D.

AU - Kloen, P.

AU - Babis, G.C.

AU - Jeray, K.J.

AU - Prayson, M.J.

AU - Pesantez, R.

AU - Acacio, R.

AU - Verbeek, D.O.

AU - Melvanki, P.

AU - Kreis, B.E.

AU - Mehta, S.

AU - Meylaerts, S.

AU - Wojtek, S.

AU - Yeap, E.J.

AU - Haapasalo, H.

AU - Kristan, A.

AU - Coles, C.

AU - Marsh, J.L.

AU - Mormino, M.

AU - Menon, M.

AU - Tyllianakis, M.

AU - Schandelmaier, P.

AU - Jenkinson, R.J.

AU - Neuhaus, V.

AU - Shahriar, C.M.H.

AU - Belangero, W.D.

AU - Kannan, S.G.

AU - Leonidovich, G.M.

AU - Davenport, J.H.

AU - Kabir, K.

AU - Althausen, P.L.

AU - Weil, Y.

AU - Toom, A.

AU - Sa Da Costa, D.

AU - Lijoi, F.

AU - Koukoulias, N.E.

AU - Manidakis, N.

AU - Van Den Bogaert, M.

AU - Patczai, B.

AU - Grauls, A.

AU - Kurup, H.

AU - Van Den Bekerom, M.P.

AU - Lansdaal, J.R.

AU - Vale, M.

AU - Ousema, P.

AU - Barquet, A.

AU - Cross, B.J.

AU - Broekhuyse, H.

AU - Haverkamp, D.

AU - Merchant, M.

AU - Harvey, E.

AU - Stojkovska Pemovska, E.

AU - Frihagen, F.

AU - Seibert, F.J.

AU - Garnavos, C.

AU - Van Der Heide, H.

AU - Villamizar, H.A.

AU - Harris, I.

AU - Borris, L.C.

AU - Brink, O.

AU - Brink, P.R.G.

AU - Choudhari, P.

AU - Swiontkowski, M.

AU - Mittlmeier, T.

AU - Tosounidis, T.

AU - Van Rensen, I.

AU - Martinelli, N.

AU - Park, D.H.

AU - Lasanianos, N.

AU - Vide, J.

AU - Engvall, A.

AU - Zura, R.D.

AU - Jubel, A.

AU - Kawaguchi, A.

AU - Goost, H.

AU - Bishop, J.

AU - Mica, L.

AU - Pirpiris, M.

AU - Van Helden, S.H.

AU - Bouaicha, S.

AU - Schepers, T.

AU - Havliček, T.

AU - Giordano, V.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - © 2016 Elsevier Ltd.Introduction Tibial plateau fracture classification systems have limited interobserver reliability and new systems emerge. The purpose of this study was to compare the reliability of the Luo classification and the Schatzker classification for two-dimensional computed tomography (2DCT) and to study the effect of adding three-dimensional computed tomography (3DCT). Materials and Methods Eighty-one observers, orthopedic surgeons and residents, were randomized to either 2DCT or 2D- and 3DCT evaluation of a spectrum of 15 complex tibial plateau fractures using web-based platforms in order to classify according to the Schatzker and according to Luo's Three Column classification. Reliability was calculated with the use of Siegel and Castellan's multirater kappa measure. Kappa values were interpreted according to the categorical rating by Landis and Koch. Results Overall interobserver reliability of the Schatzker classification was significantly better compared to the Luo classification (kSchatzker = 0.32 and kLuo = 0.28, P = 0.021), however, 'fair' for both fracture classification systems. For the Schatzker classification observers agreed significantly better on 2DCT compared to 2D- and 3DCT (k2DCT = 0.37 and k2D+3DCT = 0.29, P < 0.001). The addition of 3DCT did not improve the overall interobserver reliability for the Luo classification as well, as kappa values were not significantly different on 2DCT and 2D- and 3DCT (k2DCT = 0.31 and k2D+3DCT = 0.25, P = 0.096). Conclusions The agreement between observers was significantly better for the Schatzker classification compared to Luo's Three Column classification, however agreement was fair for both classification systems. Furthermore, the addition of 3DCT reconstructions did not improve the reliability of CT-based evaluation of tibial plateau fractures. Considering that new classification systems and 3DCT do not seem to improve agreement between surgeons, other efforts are needed that lead to more reliable diagnosis of complex tibial plateau fractures.

AB - © 2016 Elsevier Ltd.Introduction Tibial plateau fracture classification systems have limited interobserver reliability and new systems emerge. The purpose of this study was to compare the reliability of the Luo classification and the Schatzker classification for two-dimensional computed tomography (2DCT) and to study the effect of adding three-dimensional computed tomography (3DCT). Materials and Methods Eighty-one observers, orthopedic surgeons and residents, were randomized to either 2DCT or 2D- and 3DCT evaluation of a spectrum of 15 complex tibial plateau fractures using web-based platforms in order to classify according to the Schatzker and according to Luo's Three Column classification. Reliability was calculated with the use of Siegel and Castellan's multirater kappa measure. Kappa values were interpreted according to the categorical rating by Landis and Koch. Results Overall interobserver reliability of the Schatzker classification was significantly better compared to the Luo classification (kSchatzker = 0.32 and kLuo = 0.28, P = 0.021), however, 'fair' for both fracture classification systems. For the Schatzker classification observers agreed significantly better on 2DCT compared to 2D- and 3DCT (k2DCT = 0.37 and k2D+3DCT = 0.29, P < 0.001). The addition of 3DCT did not improve the overall interobserver reliability for the Luo classification as well, as kappa values were not significantly different on 2DCT and 2D- and 3DCT (k2DCT = 0.31 and k2D+3DCT = 0.25, P = 0.096). Conclusions The agreement between observers was significantly better for the Schatzker classification compared to Luo's Three Column classification, however agreement was fair for both classification systems. Furthermore, the addition of 3DCT reconstructions did not improve the reliability of CT-based evaluation of tibial plateau fractures. Considering that new classification systems and 3DCT do not seem to improve agreement between surgeons, other efforts are needed that lead to more reliable diagnosis of complex tibial plateau fractures.

U2 - 10.1016/j.injury.2015.12.022

DO - 10.1016/j.injury.2015.12.022

M3 - Article

SN - 0020-1383

VL - 47

SP - 944

EP - 949

JO - Injury

JF - Injury

IS - 4

ER -

Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures

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