Comparable outcomes with intramedullary nail and plate constructs for Schatzker VI tibial plateau fractures.

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Abstract

[Indexed for MEDLINE] 19. JB JS Open Access. 2024 Oct 3;9(4):e23.00181. doi: 10.2106/JBJS.OA.23.00181. eCollection 2024 Oct-Dec. Intrarater and Inter-rater Reliability of Tibial Plateau Fracture Classifications: Systematic Review and Meta-Analysis. Vosoughi F(1), Menbari Oskouie I(2), Rahimdoost N(3), Kasaeian A(4)(5)(6), Sherafat Vaziri A(3). Author information: (1)Department of orthopedics and trauma surgery, Tehran University of Medical Sciences, Tehran, Iran. (2)Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran. (3)Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran. (4)Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. (5)Research Center for Chronic Inflammatory Diseases, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. (6)Clinical Research Development Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. BACKGROUND: The interobserver and intraobserver reliability of various tibial plateau fracture (TPF) classifications has been examined in recent literature using radiography, computed tomography, and magnetic resonance imaging. The question remains as to which classification system provides the highest reliability. In this systematic review, we are going to evaluate the overall interobserver and intraobserver reliability of various TPF classifications in different imaging modalities. METHODS: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In February 2023, predefined terms were used for database search (Embase, PubMed, Scopus, Cochrane, and Web of Science). Meta-analysis of intrarater and inter-rater kappa coefficients was performed for each of the classifications in each modality. RESULTS: Thirty-four studies were included in this review. Schatzker's classification was more frequently used than others. It had a better intrarater kappa coefficient than the Hohl and Moore and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classifications in radiography (κ = 0.72, 95% confidence interval [CI] = 0.67-0.76, p < 0.01). The Schatzker and AO/OTA classifications had similar inter-rater reliability in the radiography modality (κ = 0.53, 95% CI = 0.51-0.54, p < 0.01; κ = 0.53, 95% CI = 0.5-0.55, p < 0.01; respectively). In 3-dimensional computed tomography, the Luo classification system showed the highest intrarater (κ = 0.85, 95% CI = 0.35-0.66) and inter-rater (κ = 0.77, 95% CI = 0.73-0.81) kappa coefficients. CONCLUSION: Three-column classification proposed by Luo et al. was able to reach the highest degree and was the only classification with near-excellent inter-rater reliability. Copyright © 2024 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. DOI: 10.2106/JBJS.OA.23.00181 PMCID: PMC11444555