ANALYSIS OF THE REPRODUCIBILITY OF TIBIAL PLATEAU FRACTURES' CLASSIFICATION

Evaluation of the Interobserver Agreement of the Fraser and Blake & McBryde Classifications for Floating Knee

Objective  To evaluate the interobserver agreement of two classifications for floating knee: Fraser and Blake & McBryde. Method  Thirty-two observers, subdivided according to the degree of titration (26 resident physicians and 6 orthopedic physicians specialized in orthopedic trauma), classified 15 fractures of the ipsilateral femur and tibia. Interobserver agreement was evaluated by using the Kappa coefficient . Result  When evaluating the agreement between the 9 R1, a Kappa index of 0.58 was obtained for the Fraser classification and of 0.46 for the Blake & McBryde classification. Among the 7 R2, a rate of 0.59 was obtained for the Fraser rating and 0.51 for the Blake & McBryde rating. Among the 10 R3, the agreement index was higher for both classifications: 0.72 for the Fraser and 0.71 for the Blake & McBryde classification. Considering the 3 groups (R1, R2, R3) as one large group, the general Kappa index was calculated, which resulted in 0.63 for the Fraser classification and 0.56 for the Blake & McBryde classification. In the group of trauma and orthopedic knee specialists, in turn, an agreement of 0.597 was obtained for the Blake and McBryde classification and of 0.843 for the Fraser classification. Conclusion  Comparatively, the two classifications presented a weak to moderate degree of agreement. Fraser classification had better agreement in both groups. The agreement was higher when evaluating orthopedic trauma physicians.

REPRODUCIBILITY OF SCHATZKER CLASSIFICATION THROUGH SMARTPHONE APPLICATIONS

OBJECTIVE

To evaluate the intra-observer reproducibility of Schatzker classification for tibial plateau fractures through smartphone applications.

METHODS

Radiographs were evaluated in two incidences (anteroposterior and profile) and CT slices (axial, sagittal and coronal) of 37 patients with tibial plateau fracture. Two evaluators, knee surgery experts, classified the cases by viewing the images of the isolated radiographs and then X-rays associated with CT slices in four different stages via smartphones and then presential assessment. Data were statistically analyzed with the Kappa coefficient (k).

RESULTS

There was intra-observer agreement by comparing the two methods of evaluation: display or via smartphone, and the analysis made showed statistical significance.

CONCLUSION

The use of smartphones did not affect the reliability of Schatzker classification. Level of Evidence III, Diagnostic Study - Investigating a Diagnostic Test.

Importance of radiological studies by means of computed tomography for managing fractures of the tibial plateau

OBJECTIVES

To evaluate the concordance among knee surgery specialists regarding the classification and surgical technique indicated in cases of tibial plateau fracture, using conventional radiographs and computed tomography.

METHODS

Forty-four patients with fractures of the tibial plateau shown on radiographic and tomographic images were selected. These were evaluated by specialists at two different times, with an interval of seven days. On the first occasion, the specialists only had access to the radiographs, while on the second occasion they had access to both radiographs and computed tomography images. Their concordance was evaluated by means of the kappa coefficient.

RESULTS

The interobserver reliability of the Schatzker classification on the first occasion was 0.36 and on the second occasion, 0.35. This was considered to present low reproducibility. In evaluating the intra-observer reproducibility of this classification, the mean kappa index was 0.42, which was classified as moderate. From evaluating the choice of surgical access, the inter-observer reliability was 0.55 on the first occasion and 0.50 on the second, which was considered to present moderate reproducibility. Evaluation on the implant chosen showed that the interobserver reliability was 0.01 on the first occasion and -0.06 on the second, which was considered to be poor and discordant. In evaluating the classification of the three columns, the inter-observer reproducibility was 0.47 (p < 0.0001), which was classified as moderate concordance.

CONCLUSION

Use of computed tomography did not present any improvement in the inter-observer concordance, using the Schatzker classification, and did not produce any change in the preoperative planning.

Repruducibility of tronzo and ao/asif classifications for transtrochanteric fractures

Objective:

To assess the reproducibility of Tronzo and AO/ASIF classifications for transtrochanteric fractures, in order to determine the most appropriate classification for clinical application, and to evaluate the influence of the level of experience of the observers in the agreement between evaluations.

Methods:

We selected 30 radiographic images of transtrochanteric fractures of the femur, which were presented to two groups of observers, one formed by expert physicians and the other by resident physicians.

Results:

When evaluated together, Tronzo classification obtained a Kappa value of 0.44. The same classification assessed by the expert group obtained a value of 0.46, while the group of residents' value was 0.44. Evaluating the AO/ASIF classification of the complete pool analysis the value found was 0.42. For the same classification, analyzed by the expert group, obtained a value of 0.41, and by the group of residents, the Kappa value achieved was 0.42. However, when analyzed in its simplified form, the AO/ASIF classification obtained Kappa values of 0.70 (pooled analysis), 0.68 (experts) and 0.72 (residents), considered concurrent.

Conclusion:

The AO/ASIF simplified classification showed substantial reproducibility and is, therefore, recommended as the most suitable for clinical application. The level of experience of the observers did not influence significantly the agreement between evaluations. Level of Evidence III, Diagnostic Study - Investigating a Diagnostic Test.

Epidemiological study on tibial plateau fractures at a level I trauma center

OBJECTIVES:

To review the epidemiological aspects of fractures of the tibial plateau in a level one hospital.

METHODS:

We retrospectively analyzed 239 tibial plateau fractures treated surgically. We took into account age, gender, trauma mechanism, classification of the injuries, associated injuries and affected side.

RESULTS:

168 were male, the fifth decade has been the most affected, the mechanism of trauma, car accident was the main causal fator, 128 cases were on the left side and 22,6% had associated injuries.

CONCLUSIONS:

Most patients were male, in the fifth decade of life, and victim of traffic accidents, and the depression and shear fractures of the tibial plateau are the most frequent. Associated lesions were infrequent in our study. Level of Evidence II, Prognostic Studies. Investigating the Effect of a Patient Characteristic on the Outcome of Disease.