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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 differentiation on AP plain radiographs, between Schatzker type 1 (a lateral split fracture) and type 2 (b lateral split fracture with depression) is more difficult than Schatzker type 1 and type 6 (c fracture with diaphysial discontinuity)
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Fig4: The differentiation on AP plain radiographs, between Schatzker type 1 (a lateral split fracture) and type 2 (b lateral split fracture with depression) is more difficult than Schatzker type 1 and type 6 (c fracture with diaphysial discontinuity)

Mentions: Brunner et al. recently published a study with four observers and 45 retrospectively selected consecutive patients that demonstrates a better interobserver agreement [kappa value for plain radiographs (0.42) vs. CT scan (0.76)] for classification of tibial plateau fractures with additional CT scans [2] However, patients who did not had CT scans as part of the initial fracture management were excluded from this study, an aspect that might cause bias as a result of unequal selection of types. For example, the differentiation between a Schatzker type 1 and 2 is more difficult with plain radiographs than between a Schatzker type 1and 6 (Fig. 4). In contrast with Brunner, we selected the whole range of types of fractures twice. Compared with that study, our set of selected cases was smaller (15 vs. 45). However, we consulted more observers (8 vs. 4), increasing the reliability and validity of our study.Fig. 4


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 differentiation on AP plain radiographs, between Schatzker type 1 (a lateral split fracture) and type 2 (b lateral split fracture with depression) is more difficult than Schatzker type 1 and type 6 (c fracture with diaphysial discontinuity)
© Copyright Policy
Related In: Results  -  Collection

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

Fig4: The differentiation on AP plain radiographs, between Schatzker type 1 (a lateral split fracture) and type 2 (b lateral split fracture with depression) is more difficult than Schatzker type 1 and type 6 (c fracture with diaphysial discontinuity)
Mentions: Brunner et al. recently published a study with four observers and 45 retrospectively selected consecutive patients that demonstrates a better interobserver agreement [kappa value for plain radiographs (0.42) vs. CT scan (0.76)] for classification of tibial plateau fractures with additional CT scans [2] However, patients who did not had CT scans as part of the initial fracture management were excluded from this study, an aspect that might cause bias as a result of unequal selection of types. For example, the differentiation between a Schatzker type 1 and 2 is more difficult with plain radiographs than between a Schatzker type 1and 6 (Fig. 4). In contrast with Brunner, we selected the whole range of types of fractures twice. Compared with that study, our set of selected cases was smaller (15 vs. 45). However, we consulted more observers (8 vs. 4), increasing the reliability and validity of our study.Fig. 4

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