Related Experiment Video
Updated: May 8, 2026
Assessment of Bone Fracture Healing Using Micro-Computed Tomography
Published on: December 9, 2022
Three-column classification and Schatzker classification: a three- and two-dimensional computed tomography
Sheethal Prasad Patange Subba Rao1, James Lewis, Ziad Haddad
1Department of Orthopaedics, University Hospital of Wales, 84 Colchester Avenue Penylan, Cardiff, UK, patangesubbarao@gmail.com.
Objective:
The aim of the study was to evaluate inter-observer reliability and intra-observer reproducibility between the three-column classification and Schatzker classification systems using 2D and 3D CT models.
Materials And Methods:
Fifty-two consecutive patients with tibial plateau fractures were evaluated by five orthopaedic surgeons. All patients were classified into Schatzker and three-column classification systems using x-rays and 2D and 3D CT images. The inter-observer reliability was evaluated in the first round and the intra-observer reliability was determined during the second round 2 weeks later.
Results:
The average intra-observer reproducibility for the three-column classification was from substantial to excellent in all sub classifications, as compared with Schatzker classification. The inter-observer kappa values increased from substantial to excellent in three-column classification and to moderate in Schatzker classification The average values for three-column classification for all the categories are as follows: (I-III) k2D = 0.718, 95% CI 0.554-0.864, p < 0.0001 and average 3D = 0.874, 95% CI 0.754-0.890, p < 0.0001. For Schatzker classification system, the average values for all six categories are as follows: (I-VI) k2D = 0.536, 95% CI 0.365-0.685, p < 0.0001 and average k3D = 0.552 95% CI 0.405-0.700, p < 0.0001. The values are statistically significant.
Conclusion:
Statistically significant inter-observer values in both rounds were noted with the three-column classification, making it statistically an excellent agreement. The intra-observer reproducibility for the three-column classification improved as compared with the Schatzker classification. The three-column classification seems to be an effective way to characterise and classify fractures of tibial plateau.
Related Concept Videos
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
01:18Classification of Bones
Long and Short Bones
The appendicular skeleton, particularly the upper and lower limbs, is primarily made of long and short bones. The long...
01:09Functional Classification of Joints
The functional classification of joints is determined by the amount of mobility between the adjacent bones. Joints are functionally classified as a synarthrosis or immobile joint, an amphiarthrosis or slightly moveable joint, or as a diarthrosis, a freely moveable joint. Fibrous and cartilaginous joints can be functionally classified as either synarthroses or amphiarthroses, whereas all synovial joints are classified as diarthroses.
Synarthrosis
An immobile...