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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2024

Open Access 28-09-2023 | Tibial Plateau Fracture | Review Article

The effect of addition of 2DCT scans and 3DCT scans for the classification of tibial plateau fractures: a systematic review

Authors: Jellina Mariska Huitema, Nynke van der Gaast, Ruurd Lukas Jaarsma, Job Nicolaas Doornberg, Michael John Richard Edwards, Erik Hermans

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2024

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Abstract

Purpose

In this systematic review, we evaluate the effect of radiographs and 2D and 3D imaging techniques on the interobserver agreement of six commonly used classification systems for tibial plateau fractures.

Methods

In accordance with PRISMA guidelines, PubMed, Cochrane, Embase and Web of Science were searched for studies regarding the effect of 2D and 3D imaging techniques on the interobserver agreement of tibial plateau classification systems. Studies validating new classification systems, not providing own data or only providing information on the interobserver agreement for radiographs were excluded. Studies were scored based on the ROBINS-I risk of bias tool.

Results

Our review analysed 14 studies on different classification systems used for tibial plateau fractures in clinical practice, with the Schatzker classification being the most commonly used classification system. The results showed that the addition of 2D CT led to a significant improvement of interobserver agreement for one study. However, other included studies showed varying levels of interobserver agreement, ranging from fair to substantial according to the interpretation by Landis and Koch. The addition of 3D CT resulted in a significant deterioration in one study for the Schatzker classification. Similar to the addition of 2D CT, the interobserver agreement for the Schatzker classification with the addition of 3D CT were heterogeneous ranging from fair to almost perfect according to the interpretation by Landis and Koch.

Conclusions

The use of 2D CT can be recommended for classifying tibial plateau fractures with the Schatzker classification, AO/OTA classification and Hohl classification. The value of 3D CT on the interobserver agreement of commonly used classification systems remains uncertain and unproven. Therefore, we do not recommend the use of 3D CT for the classification of tibial plateau fractures. Overall, the advancement of imaging techniques is not in line with the advancement in interobserver agreement on fracture classification.
Appendix
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Literature
1.
Palmer I. Fractures of the upper end of the tibia. J Bone Jt Surg Br. 1951;33b(2):160–6.
2.
Hohl M, Luck JV. Fractures of the tibial condyle; a clinical and experimental study. J Bone Jt Surg Am. 1956;38-a(5): 1001–18.
3.
Hohl M. Tibial condylar fractures. J Bone Jt Surg Am. 1967;49(7):1455–67.CrossRef
4.
Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res. 1979(138); 94–104.
5.
Marsh JL, et al. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 Suppl):S1-133.CrossRefPubMed
6.
Duparc J, Ficat P. Articular fractures of the upper end of the tibia. Rev Chir Orthop Reparatrice Appar Mot. 1960;46:399–486.PubMed
7.
Luo CF, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010;24(11):683–92.CrossRefPubMed
8.
Krause M, et al. Intra-articular tibial plateau fracture characteristics according to the “ten segment classification.” Injury. 2016;47(11):2551–7.CrossRefPubMed
9.
Kfuri M, Schatzker J. Revisiting the Schatzker classification of tibial plateau fractures. Injury. 2018;49(12):2252–63.CrossRefPubMed
10.
O’Toole RV, et al. Evaluation of computed tomography for determining the diagnosis of acetabular fractures. J Orthop Trauma. 2010;24(5):284–90.CrossRefPubMed
11.
Yang TW, et al. Diagnostic performance of cone-beam computed tomography for scaphoid fractures: a systematic review and diagnostic meta-analysis. Sci Rep. 2021;11(1):2587.CrossRefPubMedPubMedCentral
12.
Rupp GE, et al. A comparison of cone beam computed tomography, standard computed tomography and plain radiographs in the evaluation of medial epicondyle humerus fractures. J Pediatr Orthop B. 2022;31(5):434–41.CrossRefPubMed
13.
Millar SC, et al. A systematic literature review of tibial plateau fractures: what classifications are used and how reliable and useful are they? Injury. 2018;49(3):473–90.CrossRefPubMed
14.
Bruinsma WE, et al. Interobserver reliability of classification and characterization of proximal humeral fractures: a comparison of two and three-dimensional CT. J Bone Jt Surg Am. 2013;95(17):1600–4.CrossRef
15.
Berkes MB, et al. The impact of three-dimensional CT imaging on intraobserver and interobserver reliability of proximal humeral fracture classifications and treatment recommendations. J Bone Jt Surg Am. 2014;96(15):1281–6.CrossRef
16.
Arealis G, et al. Does the CT improve inter- and intra-observer agreement for the AO, Fernandez and Universal classification systems for distal radius fractures? Injury. 2014;45(10):1579–84.CrossRefPubMed
17.
Foroohar A, et al. Classification and treatment of proximal humerus fractures: inter-observer reliability and agreement across imaging modalities and experience. J Orthop Surg Res. 2011;6:38.CrossRefPubMedPubMedCentral
18.
19.
20.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMed
21.
22.
Brunner A, et al. Classification systems for tibial plateau fractures; does computed tomography scanning improve their reliability? Injury. 2010;41(2):173–8.CrossRefPubMed
23.
Taşkesen A, et al. Intraobserver and interobserver reliability assessment of tibial plateau fracture classification systems. Eklem Hastalik Cerrahisi. 2017;28(3):177–81.MathSciNetCrossRefPubMed
24.
Castiglia MT, et al. The impact of computed tomography on decision making in tibial plateau fractures. J Knee Surg. 2018;31(10):1007–14.CrossRefPubMed
25.
te Stroet MAJ, et al. The value of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures. Emerg Radiol. 2011;18(4):279–83.CrossRef
26.
Chan PS, et al. Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma. 1997;11(7):484–9.CrossRefPubMed
27.
de Lima Lopes C, et al. Importance of radiological studies by means of computed tomography for managing fractures of the tibial plateau. Rev Bras Ortop. 2014;49(6):593–601.PubMedPubMedCentral
28.
Gicquel T, et al. Tibial plateau fractures: reproducibility of three classifications (Schatzker, AO, Duparc) and a revised Duparc classification. Orthop Traumatol Surg Res. 2013;99(7):805–16.CrossRefPubMed
29.
Masouros PT, et al. Interobserver reliability of Schatzker, AO Foundation-Orthopaedic Trauma Association, and Luo classifications for tibial plateau fractures: does three-dimensional CT improve outcomes? Cureus. 2022;14(2): e22227.PubMedPubMedCentral
30.
Mellema JJ, et al. Tibial plateau fracture characteristics: reliability and diagnostic accuracy. J Orthop Trauma. 2016;30(5):e144–51.CrossRefPubMed
31.
Van den Berg J, et al. Value of three-dimensional computed tomography reconstruction in the treatment of posterior tibial plateau fractures. Knee. 2020;27(1):3–8.CrossRefPubMed
32.
Doornberg JN, et al. Two-dimensional and three-dimensional computed tomography for the classification and characterisation of tibial plateau fractures. Injury. 2011;42(12):1416–25.CrossRefPubMed
33.
Patange Subba Rao SP, et al. Three-column classification and Schatzker classification: a three- and two-dimensional computed tomography characterisation and analysis of tibial plateau fractures. Eur J Orthop Surg Traumatol. 2014;24(7):1263–70.CrossRefPubMed
34.
Hu YL, et al. Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures. Injury. 2009;40(12):1282–5.CrossRefPubMed
35.
Yao P, et al. Intra- and inter-observer reliability assessment of widely used classifications and the “ten-segment classification” of tibial plateau fractures. Knee. 2022;35:149–56.CrossRefPubMed
36.
Avci M, Kozaci N. Comparison of X-ray imaging and computed tomography scan in the evaluation of knee trauma. Medicina (Kaunas) 2019;55(10):623.
37.
Mustonen AOT, Koskinen SK, Kiuru MJ. Acute knee trauma: analysis of multidetector computed tomography findings and comparison with conventional radiography. Acta Radiol. 2005;46(8):866–74.CrossRefPubMed
38.
Bougher H, et al. Imaging to improve agreement for proximal humeral fracture classification in adult patient: a systematic review of quantitative studies. J Clin Orthopaed Trauma. 2020;11:S16–24.CrossRef
39.
Gavaghan DJ, Moore AR, McQuay HJ. An evaluation of homogeneity tests in meta-analyses in pain using simulations of individual patient data. Pain. 2000;85(3):415–24.CrossRefPubMed
40.
Mellema JJ, et al. Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures. Injury. 2016;47(4):944–9.CrossRefPubMed
41.
Huitema JM, et al. Are 3D-printed models of tibial plateau fractures a useful addition to understanding fractures for junior surgeons? Clin Orthop Relat Res. 2022;480(6):1170–7.CrossRefPubMedPubMedCentral
42.
Brouwers L et al. The value of 3D printed models in understanding acetabular fractures. 3D Print Addit Manuf. 2018;5: 37–46.
43.
Brouwers L, et al. What is the value of 3D virtual reality in understanding acetabular fractures? Eur J Orthopaed Surg Traumatol Orthoped Traumatol. 2020;30(1):109–16.CrossRef
Metadata
Title
The effect of addition of 2DCT scans and 3DCT scans for the classification of tibial plateau fractures: a systematic review
Authors
Jellina Mariska Huitema
Nynke van der Gaast
Ruurd Lukas Jaarsma
Job Nicolaas Doornberg
Michael John Richard Edwards
Erik Hermans
Publication date
28-09-2023
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2024
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-023-02344-3

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