Value Of Computed Tomography In Tibial Plateau Fracture Classification

Objective:To study the consistency of Schatzker classification system,CT-based Schatzker classification system and Three-column classification system,and to discuss the significance of the TC usage in tibial plateau fracture classification.Methods:Cases were collected from the First Affiliated Hospital of Chongqing Medical University during March 2016 to January 2019 using HIS,and the X-ray and CT images were obtained from PACS.Two Surgeons independently classified all cases using Schatzker classification system,CT-based Schatzker classification system and Three-column classification system and record the results.The process was repeated using the same but randomized imaging data two months later.Calculate the Kappa values and analyze the reliability and validity values of the three classification systems.Result:For Schatzker classification system,the intra-observer reliability was at the Substantial level,and the inter-observer reliability was at the Moderate level.For CT-based Schatzker classification system and the three-column classification system,the intra-observer reliability was at the Almost Perfect level,and the inter-observer reliability was at the Substantial level.For Schatzker classification system,the intra-observer validity was 82.1%,and the inter-observer validity was 62.7%.For CT-based Schatzker classification system,the intra-observer validity was94.8%,and the inter-observer validity was 79.4%.For three-column classification system,the intra-observer validity was 93.0%,and the inter-observer validity was 79.4%.Significant statistic difference was found between Schatzker classification system and CT-based Schatzker classification system(Χ~2=234.86,p<0.001).Conclusion:Except for Schatzker IV and V,the agreement between Schatzker classification and CT-based Schatzker classification is lower than75%.So CT scanning and 3D-reconstruction is recommended when a patient is diagnosed tibial plateau fracture in X-ray film.