The classification systems for tibial plateau fractures: How reliable are they?

SummaryObjectiveThe aim of the study was to assess the inter-observer reliability and intra-observer reproducibility of three different classification systems for tibial plateau fractures.Materials and methodsFour observers of various levels of experience classified 50 tibial plateau fractures. The same observers repeated the classification of the same fractures after an interval of 8 weeks. Inter- and intra-observer variability was assessed using the mean κ co-efficient and the mean percentage of agreement.ResultsFor inter-observer reliability, the mean κ co-efficient values for Arbeitsgemeinschaft für Osteosynthesefragen (AO), Schatzker and Hohl and Moore classifications were 0.36, 0.47 and 0.14, respectively. The mean percentage of agreement was 0.52, 0.59 and 0.34, respectively. For intra-observer reliability κ-values were 0.80, 0.91 and 0.76 and the mean percentage of agreement was 0.88, 0.93 and 0.85 in the same order.ConclusionsOur results show that none of the classification systems were ideal. The Schatzker classification system was superior to the AO and the Hohl and Moore systems both in terms of inter-observer reliability and intra-observer reproducibility. However, there is a need for developing a more comprehensive approach to judge the classification systems.