The Validity and Reliability of CT Scan Based Tibial Plateau Mapping for Tibial Plateau Fractures

Abstract Background Tibial plateau fractures are intra-articular fractures presume a threat to knee function and represent great challenge to treat. Treatment with open reduction and internal fixation is variable because fractures vary from simple to complex, with little or extensive articular involvement. Hence, recognition of the fracture features will help orthopedic surgeons to understand the injury mechanism better and manage these fractures by planning optimal surgical procedures. Aim of the Work To assess the inter and intra-observer reliability of the new CT scan based tibial plateau classification (the ten segment tibial plateau mapping) and the secondary aim is to clarify its validity in clinical practice assisting the surgeons in choosing their approach and fixation implant during open reduction and internal fixation of such fractures. Our hypothesis is that this more sophisticated classification system may facilitate the choice of surgical approach and implants used and that this classification could be widely accepted among trauma surgeons. Patients and Methods A total of 30 patients with tibial plateau fractures diagnosed by the department of orthopedic surgery at el Demerdash hospital, Ain Shams university were collected in the time period between January 2020 and December 2022. Results in our study, we compared the inter and intra observer reliability of Schatzker, three column, and ten-segment classification using Kappa values. The results showed that schatzker and three column classification systems have higher inter-observer mean kappa values (0.749± 0.07, 0.692± 0.08) (0.639± 0.06, 0.667± 0.08 after 2 weeks‟ time interval) respectively representing good interobserver agreement in relation to the ten-segment classification which showed mean Kappa value 0.409± 0.30 representing moderate interobserver agreement when the cases were observed for the first time. The mean Kappa value decreased (0.081± 0.17) when the cases were observed after 2 weeks‟ time interval representing poor interobserver agreement. As regard to intra-observer reliability, both schatzker and three column classifications have higher mean Kappa values (0.766± 0.22, 0.697± 0.17 respectively) representing good intra-observer agreement in relation to ten segment classification which showed mean Kappa value (0.342± 0.10) representing poor intra-observer agreement. Conclusion tibial plateau fractures represent great challenge for orthopedic surgeons to treat and adequate preoperative planning is mandatory. The use CT scan with 3D reconstruction can help surgeons to describe and classify all fracture patterns thus reaching the optimal plane for fracture fixation. Our study concluded that ten segment classification has moderate to poor reliability compared to the conventional widely used schatzker classification and three column classification. We think that this because ten segment classification still not familiar to orthopedic surgeon. More research is needed on ten segment classification so that it can be applied in the future in clinical practice.