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Reliability of a four-column classification for tibial plateau fractures

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Abstract

Purpose

A four-column classification system offers a different way of evaluating tibial plateau fractures. The aim of this study is to compare the intra-observer and inter-observer reliability between four-column and classic classifications.

Methods

This is a reliability study, which included patients presenting with tibial plateau fractures between January 2013 and September 2015 in a level-1 trauma centre. Four orthopaedic surgeons blindly classified each fracture according to four different classifications: AO, Schatzker, Duparc and four-column. Kappa, intra-observer and inter-observer concordance were calculated for the reliability analysis.

Results

Forty-nine patients were included. The mean age was 39 ± 14.2 years, with no gender predominance (men: 51%; women: 49%), and 67% of the fractures included at least one of the posterior columns. The intra-observer and inter-observer concordance were calculated for each classification: four-column (84%/79%), Schatzker (60%/71%), AO (50%/59%) and Duparc (48%/58%), with a statistically significant difference among them (p = 0.001/p = 0.003). Kappa coefficient for intr-aobserver and inter-observer evaluations: Schatzker 0.48/0.39, four-column 0.61/0.34, Duparc 0.37/0.23, and AO 0.34/0.11.

Conclusions

The proposed four-column classification showed the highest intra and inter-observer agreement. When taking into account the agreement that occurs by chance, Schatzker classification showed the highest inter-observer kappa, but again the four-column had the highest intra-observer kappa value. The proposed classification is a more inclusive classification for the posteromedial and posterolateral fractures. We suggest, therefore, that it be used in addition to one of the classic classifications in order to better understand the fracture pattern, as it allows more attention to be paid to the posterior columns, it improves the surgical planning and allows the surgical approach to be chosen more accurately.

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Acknowledgements

The authors thank Dr. Helen Reina for the copy editing of this manuscript, as well as Juan Esteban Restrepo, for his help with statistical calculations and analysis.

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Authors and Affiliations

  1. Orthopaedic Surgery Department, Fundación Valle del Lili, Universidad Icesi, Calle 18 No. 122–135, Cali, Colombia

    Alfredo Martínez-Rondanelli & Juan Pablo Martínez-Cano

  2. Fundación Valle del Lili, Cali, Colombia

    Sara Sofía Escobar-González & Alejandro Henao-Alzate

  3. Fundación Valle del Lili, Cra 98 # 18–49, Consultorio 118, Cali, Colombia

    Juan Pablo Martínez-Cano

Authors
  1. Alfredo Martínez-Rondanelli
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  2. Sara Sofía Escobar-González
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  3. Alejandro Henao-Alzate
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  4. Juan Pablo Martínez-Cano
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Corresponding author

Correspondence to Juan Pablo Martínez-Cano.

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This research received no funding.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The institutional review board approved this study.

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Martínez-Rondanelli, A., Escobar-González, S.S., Henao-Alzate, A. et al. Reliability of a four-column classification for tibial plateau fractures. International Orthopaedics (SICOT) 41, 1881–1886 (2017). https://doi.org/10.1007/s00264-017-3543-x

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  • DOI: https://doi.org/10.1007/s00264-017-3543-x

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