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Wich is the most reproducible classification system to assess tibial plateau fractures?
Author(s):
Ramírez E. (Spain)
,
Ramírez E. (Spain)
Affiliations:
Millán Angelica
,
Millán Angelica
Affiliations:
Gómez Mireia
,
Gómez Mireia
Affiliations:
Ibañez M.
,
Ibañez M.
Affiliations:
Gelber Ghertner P.
Gelber Ghertner P.
Affiliations:
ESSKA Academy. Ramírez E. May 9, 2018; 209299; P02-196 Topic: Knee
Mr. Eduard Ramírez
Mr. Eduard Ramírez
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Abstract
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Objectives: The traditional classification systems of tibial plateau fractures are based on simple radiographs and have limited intraobserver and interobserver variability. Various classification schemes have been used to describe these injuries.
Among the available classification systems for tibial plateau fractures, Schatzker and AO systems are the most widely accepted. Some special cases may not be correctly delineated and comprehensively identified by the traditional classification systems, so new classifications systems emerge.
The objective was to assess intraobserver and interobserver variability using x-rays, computed tomography (CT) and 3D-reconstructions images of these and more recent classifications.

Methods: We reviewed cases of tibial plateau fracture operated at two different centers, collecting the demographic data (age, sex, BMI) and mechanism of injury. Fractures were classified by 4 observers according to the Schatzker, AO, Luo, Khan and modified Duprac. They classified twice each fracture, with a time interval of 15 days.
The statistical study was performed using a kappa test to assess intraobserver and interobserver variability.

Results: A total of 112 patients were included (71 males and 41 females) with a mean age of 47.1 and mean BMI 25.1. 64 left and 48 right knees. 24% were after low energy injury, 26% moderate and 56% high energy.
The intraobserver and interobserver variability were, respectively: 0.85 and 0.62 in AO, 0.87 and 0.65 in Schaztker, 0.86 and 0.73 in Luo, 0.56 and 0.37 in modified Duprac and 0.43 and 0.25 in Khan.

Conclusions: The different classification systems for tibial plateau fractures continue to have limited reproducibility.
Althoug previous training could be needed, AO, Schatzker and Luo showed a good reroducibility of tibial plateau fractures on CT images.
The modified Duparc and Khan classifications were less favourable and their use is therefore not recommended.

Keywords:
Tibial Plateau Fractures ; Schatzker ; AO; Luo; intraobserver ; interobserver
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