Ten-Segment Classification has Lowest Inter/Intra-Observer Reliability as Compared to Schatzker, Three-Column and AO...

Area of Science:

• Orthopedic surgery
• Traumatology
• Radiology

Background:

• Tibial plateau fractures (TPFs) require accurate classification for treatment planning.
• Existing classification systems include Schatzker, AO, and Luo's Three Columns (ThCC).
• A novel ten-segment classification system (TSC) has been proposed.

Purpose of the Study:

• To evaluate the reliability of the ten-segment classification (TSC) system for TPFs.
• To compare the TSC system's reliability against Schatzker, AO, and ThCC classifications.
• To assess inter-observer reliability based on varying levels of surgical experience.

Main Methods:

• Fifty TPFs were classified using the TSC system.
• Intra-observer and inter-observer reproducibility were assessed using kappa (k) values.
• Three groups of observers with different experience levels (junior residents, senior residents, faculty) participated.

Main Results:

• The TSC system exhibited the lowest inter-observer (k=0.08) and intra-observer (k=0.03) reliability.
• Schatzker classification showed the highest individual inter-observer (k=0.52) and intra-observer (k=0.31) reliability in junior residents.
• Inter-observer reliability for Schatzker, AO, and ThCC classifications decreased with increasing observer experience.

Conclusions:

• The ten-segment classification system demonstrates poor reliability for TPFs.
• Schatzker classification appears more reliable, particularly for less experienced surgeons.
• Increasing surgical experience may lead to more critical fracture evaluation, potentially reducing inter-observer agreement in established systems.