INTER- AND INTRA-OBSERVER RELIABILITY OF SCHATZKER, AO, AND LUO CLASSIFICATIONS FOR TIBIAL PLATEAU FRACTURES

Area of Science:

• Orthopedic Surgery
• Radiology
• Medical Imaging Analysis

Background:

• Tibial plateau fractures require accurate classification for effective treatment.
• Existing classification systems (Schatzker, AO/ASIF, Luo) vary in their reliability.
• Assessing inter- and intra-observer agreement is crucial for clinical utility.

Purpose of the Study:

• To evaluate the inter- and intra-observer agreement of Schatzker, AO/ASIF, and Luo classification systems for tibial plateau fractures.
• To compare the reproducibility of these three systems among orthopedic surgery residents.

Main Methods:

• Cross-sectional study involving 29 orthopedic residents.
• Evaluation of radiographic and tomographic knee imaging from 15 fracture patients.
• Repeated assessment after six weeks, with agreement measured by the Kappa index.

Main Results:

• AO/ASIF classification showed higher inter-observer agreement (Kappa 0.431 in test 1, 0.333 in test 2) compared to Schatzker and Luo.
• Intra-observer agreement varied by year of residency, with 2nd-year residents showing substantial agreement for AO/ASIF (0.58).
• Overall, AO/ASIF demonstrated better reproducibility across resident experience levels.

Conclusions:

• The AO/ASIF classification system offers superior reproducibility for tibial plateau fractures.
• Inter- and intra-observer agreement for AO/ASIF is substantial and improves with resident training.
• This suggests AO/ASIF is a more reliable tool for classifying these injuries.