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The value of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures.

te Stroet MA, Holla M, Biert J, van Kampen A - Emerg Radiol (2011)

Bottom Line: Agreement was measured using kappa coefficients.Using plain films alone for formulating a treatment plan, the mean interobserver kappa coefficient was 0.40, which decreased to 0.30 after addition of CT scans.Routine CT scanning of the knee for tibial plateau fractures is not supported by this study.

View Article: PubMed Central - PubMed

Affiliation: Radboud University Nijmegen Medical Centre, Postbox 9101, 6501 HB, Nijmegen, The Netherlands. martijn_testroet@hotmail.com

ABSTRACT
This study aimed to evaluate the intra- and interobserver agreement for both fracture classification according to Schatzker and treatment plan of tibial plateau fractures using plain radiographs alone and with computed tomography (CT) scans. The study was carried out prospectively to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures. Eight experienced observers (six surgeons and two radiologists) classified 15 tibial plateau fractures with plain radiographs and CT scans and set up a treatment plan. Agreement was measured using kappa coefficients. Using plain radiographs alone, the mean interobserver kappa coefficient for classification was 0.47, which decreased to 0.46 after addition of CT scans. Using plain films alone for formulating a treatment plan, the mean interobserver kappa coefficient was 0.40, which decreased to 0.30 after addition of CT scans. The mean intraobserver kappa coefficient for fracture classification using plain radiographs was 0.60, which decreased to 0.57 with addition of CT scans. The mean intraobserver kappa coefficient for treatment plan based on plain radiographs alone was 0.53, which decreased to 0.45 after addition of CT scans. In contrast with other recent publications, there is no increase in inter- and intra-agreement of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures. Routine CT scanning of the knee for tibial plateau fractures is not supported by this study.

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The classification according to Schatzker divides the tibial plateau fractures into six types: lateral split fracture (1), lateral split fracture with depression (2), central depression fracture (3), medial condyle fracture (4), bicondylar fracture (5), and fracture with diaphysial discontinuity (6)
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Fig1: The classification according to Schatzker divides the tibial plateau fractures into six types: lateral split fracture (1), lateral split fracture with depression (2), central depression fracture (3), medial condyle fracture (4), bicondylar fracture (5), and fracture with diaphysial discontinuity (6)

Mentions: After presentation of the plain radiographs, the observers were asked to classify the fractures according to Schatzker [7]. This classification is most commonly used as a guide for treatment of these fractures [8, 9]. Each increasing numeric category indicates increasing severity: increased energy imparted to the bone and worse prognosis. Management of types 1–3 centers on evaluating and repairing articular cartilage, the fracture-dislocation mechanism of type 4 increases the likelihood of injury to the peroneal nerve or popliteal vessels, and in types 5 and 6, the soft tissue status dictates the need for provisional stabilization with external fixation before definitive surgery.[10] A description of the classification with an illustration was presented to all observers during the test (Fig. 1). Next, the surgeons were asked to set up a treatment plan by selecting multiple options considering the surgical approach, the type of reduction, and stabilization (Table 1). Finally, they were asked if they would consider a CT scan necessary. After presentation of the CT scan, the classification was reconsidered, as well as the treatment plan.Fig. 1


The value of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures.

te Stroet MA, Holla M, Biert J, van Kampen A - Emerg Radiol (2011)

The classification according to Schatzker divides the tibial plateau fractures into six types: lateral split fracture (1), lateral split fracture with depression (2), central depression fracture (3), medial condyle fracture (4), bicondylar fracture (5), and fracture with diaphysial discontinuity (6)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3139878&req=5

Fig1: The classification according to Schatzker divides the tibial plateau fractures into six types: lateral split fracture (1), lateral split fracture with depression (2), central depression fracture (3), medial condyle fracture (4), bicondylar fracture (5), and fracture with diaphysial discontinuity (6)
Mentions: After presentation of the plain radiographs, the observers were asked to classify the fractures according to Schatzker [7]. This classification is most commonly used as a guide for treatment of these fractures [8, 9]. Each increasing numeric category indicates increasing severity: increased energy imparted to the bone and worse prognosis. Management of types 1–3 centers on evaluating and repairing articular cartilage, the fracture-dislocation mechanism of type 4 increases the likelihood of injury to the peroneal nerve or popliteal vessels, and in types 5 and 6, the soft tissue status dictates the need for provisional stabilization with external fixation before definitive surgery.[10] A description of the classification with an illustration was presented to all observers during the test (Fig. 1). Next, the surgeons were asked to set up a treatment plan by selecting multiple options considering the surgical approach, the type of reduction, and stabilization (Table 1). Finally, they were asked if they would consider a CT scan necessary. After presentation of the CT scan, the classification was reconsidered, as well as the treatment plan.Fig. 1

Bottom Line: Agreement was measured using kappa coefficients.Using plain films alone for formulating a treatment plan, the mean interobserver kappa coefficient was 0.40, which decreased to 0.30 after addition of CT scans.Routine CT scanning of the knee for tibial plateau fractures is not supported by this study.

View Article: PubMed Central - PubMed

Affiliation: Radboud University Nijmegen Medical Centre, Postbox 9101, 6501 HB, Nijmegen, The Netherlands. martijn_testroet@hotmail.com

ABSTRACT
This study aimed to evaluate the intra- and interobserver agreement for both fracture classification according to Schatzker and treatment plan of tibial plateau fractures using plain radiographs alone and with computed tomography (CT) scans. The study was carried out prospectively to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures. Eight experienced observers (six surgeons and two radiologists) classified 15 tibial plateau fractures with plain radiographs and CT scans and set up a treatment plan. Agreement was measured using kappa coefficients. Using plain radiographs alone, the mean interobserver kappa coefficient for classification was 0.47, which decreased to 0.46 after addition of CT scans. Using plain films alone for formulating a treatment plan, the mean interobserver kappa coefficient was 0.40, which decreased to 0.30 after addition of CT scans. The mean intraobserver kappa coefficient for fracture classification using plain radiographs was 0.60, which decreased to 0.57 with addition of CT scans. The mean intraobserver kappa coefficient for treatment plan based on plain radiographs alone was 0.53, which decreased to 0.45 after addition of CT scans. In contrast with other recent publications, there is no increase in inter- and intra-agreement of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures. Routine CT scanning of the knee for tibial plateau fractures is not supported by this study.

Show MeSH
Related in: MedlinePlus