Evaluation of the Reproducibility of the Schatzker Classification Reviewed by Kfuri for Tibial Plateau Fractures

Objective  The Schatzker classification is the most used for tibial plateau fractures. Kfuri et al. 12 reviewed Schatzker's initial classification describing in more detail the involvement of the tibial plateau in the coronal plane, allowing a better understanding of the fracture pattern and a more accurate surgical planning. The objectives of the present study are to evaluate the interobserver agreement of these classifications and to evaluate the influence of the experience of the observer on the reproducibility of the instruments. Methods  An observational and retrospective study was conducted by evaluating the radiological study of 20 adult individuals with tibial plateau fractures, including radiographs and computed tomography (CT). The fractures were classified once by 34 examiners with varied experience (24 specialists and 10 residents in Orthopedics and Traumatology), according to the Schatzker classification and to the modification proposed by Kfuri. The Fleiss Kappa index was used to verify interobserver agreement. Results  The interobserver agreement index was considered moderate for the Schatzker classification (κ = 0.46) and mild for the Kfuri modification (κ = 0.30). The Schatzker classification showed moderate agreement, with κ = 0.52 for residents and κ = 0.45 among specialists. The Kfuri classification showed mild agreement, with Kappa values for residents and specialists of 0.39 and 0.28, respectively. Conclusion  The Schatzker classification and the classification modified by Kfuri presented moderate and mild interobserver agreement, respectively. In addition, the residents presented higher agreement than the specialists for the two systems studied.