Computed tomography-based Three-Column Classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility

Abstract

Background: The purpose of our study is to introduce a new Three-Column Classification for tibial plateau fractures and evaluate its reproducibility and reliability.

Methods: From December 2004 to December 2006, 278 consecutive patients with tibial plateau fractures were treated operatively at the Department of Orthopedics and Trauma III in Shanghai Sixth People's Hospital. Computed tomography (CT) and three-dimensional reconstruction were preformed for each patient before open reduction and internal fixation. The approaches were instructed by the Three-Column Classification. To test the reproducibility of the Three-Column Classification, the interobserver and intraobserver reliability of this classification system compared with that of the Schatzker Classification was investigated by four observers.

Results: Fourteen cases could not be classified by Schatzker Classification. Meanwhile, all cases could be classified by the Three-Column Classification. Using plain radiographs, the mean κ values for interobserver reliability using Schatzker Classification systems were 0.567 (range, 0.513-0.589), representing "moderate agreement," whereas the mean κ values were 0.766 (range, 0.706-0.890), representing "substantial agreement" by the use of the Three-Column Classification based on the CT scan. The mean κ values for intraobserver reliability using Schatzker Classification and the Three-Column Classification based on the CT scan were 0.758 (range, 0.691-0.854) and 0.810 (range, 0.745-0.918), respectively, representing "substantial agreement."

Conclusion: The Three-Column Classification demonstrates a higher interobserver reliability and can be used as a supplement to the conventional Schatzker Classification, especially in the complex and posterior comminuted tibial plateau fractures. Furthermore, the Three-Column Classification is clinically relevant and, to some degree, can instruct the surgeon in preoperative planning.

Level of evidence: Diagnostic study, level III.