Ten-Segment Classification has Lowest Inter/IntraObserver Reliability as Compared to Schatzker, ThreeColumn and AO Systems for Tibial Plateau Fractures: A Comparison Based on Surgeons' Experience | ||
| The Archives of Bone and Joint Surgery | ||
| مقاله 6، دوره 11، شماره 4، تیر 2023، صفحه 256-262 اصل مقاله (765.52 K) | ||
| نوع مقاله: RESEARCH PAPER | ||
| شناسه دیجیتال (DOI): 10.22038/abjs.2022.63442.3061 | ||
| نویسندگان | ||
| Nitesh Gahlot* 1؛ Kishore Kunal2؛ Abhay Elhence3؛ Umesh Meena1؛ Akshat Gupta4؛ Jeshwanth Netaji4؛ Dharampal Swami5؛ Meghal Goyal5؛ Ashraf Jamal5 | ||
| 1Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India | ||
| 2Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Jodhpur, India | ||
| 3Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Jodhpur, India | ||
| 4All India Institute of Medical Sciences (AIIMS), Jodhpur, India | ||
| 5Department. of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Jodhpur, India | ||
| چکیده | ||
| Objectives: The primary aim of this study was to assess the reliability of the ten -segment classification system proposed (TSC) by Krause et al. and see how it compares with the traditionally used Schatzker classification, AO classification system, and Luo’s “Three columns” classification (ThCC) system. The second aim of this study was to assess the inter-observer reliability of the above classifications based on professional experience by comparing the entry level of residents (1 year into postgraduation), senior residents (1 year after postgraduation completion), and faculty (>10 years after postgraduation completion). Methods: 50 TPFs were classified by a 10-segment classification system, and its intra-observer (at 1-month interval) and inter-observer reproducibility was checked using k values by three different groups with varying levels of experience (Group I, II, and III comprised of 2 juniors residents, senior residents and consultants each), and the same was compared for three other common classification systems (Schatzker, AO and 3 –column). Results: 10-segment classification showed least k for both inter-observer (0.08) and intra-observer (0.03) reliability. Highest individual inter-observer (k= 0.52) and intra-observer reliability (k= 0.31) was for Schatzker classification in Group I. Lowest individual inter-observer and intra-observer reliability was seen for 10-segment classification (k= 0.07) and AO classification system (k= -0.03) respectively. Conclusion: 10-segment classification showed the lowest k for both inter-observer and intra-observer reliability. The inter-observer reliability for the Schatzker, AO, and 3- column classifications reduced with increasing experience of the observer (JR>SR>Consultant). A possible reason could be a more critical evaluation of the fractures with increasing seniority. Level of evidence: I | ||
| کلیدواژهها | ||
| Clinical competence؛ Computer-assisted؛ Image processing؛ Observer variation؛ Tomography؛ X-Ray computed | ||
| مراجع | ||
|
1. Elsoe R, Larsen P, Nielsen NP, Swenne J, Rasmussen S, Ostgaard SE. Population-Based Epidemiology of Tibial Plateau Fractures. Orthopedics. 2015; 38(9):e780-6. doi:10.3928/01477447-20150902-55 2. Gerard-Marchant P. Fractures des plateaux tibiaux. Rev Chir Orthop. 2002; 26:499-546. 3. Huten D, Duparc J, Cavagna R. Fracture's récentes des plateaux tibiaux de l’adulte. Editions techniques, EMC (Paris, France), Appareil locomoteur. 1990; 14082:A10. 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. Müller ME, Nazarian S, Koch P, eds. Classification AO des fractures: 1: Les os longs. French Edition. Springer-Verlag; 1987. 6. Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010; 24(11):683-92. doi:10.1097/BOT.0b013e3181d436f3 7. Krause M, Preiss A, Muller G, et al. Intra-articular tibial plateau fracture characteristics according to the "Ten segment classification". Injury. 2016; 47(11):2551-2557. doi:10.1016/j.injury.2016.09.014 8. Wang Y, Luo C, Zhu Y, et al. Updated Three-Column Concept in surgical treatment for tibial plateau fractures - A prospective cohort study of 287 patients. Injury. 2016; 47(7):1488-96. doi:10.1016/j.injury.2016.04.026 9. Zhu Y, Yang G, Luo CF, et al. Computed tomography-based Three-Column Classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility. J Trauma Acute Care Surg. 2012; 73(3):731-7. doi:10.1097/TA.0b013e31825c17e7 10. Chang SM, Hu SJ, Zhang YQ, et al. A surgical protocol for bicondylar four-quadrant tibial plateau fractures. Int Orthop. 2014; 38(12):2559-64. doi:10.1007/s00264-014-2487-7 11. Dhillon MS, Patel S, Puneeth K. Simple four column classification can dictate treatment for intra articular tibial plateau fractures much better than ten segment classification. Injury. 2017; 48(6):1276-1278. doi:10.1016/j.injury.2017.03.031 12. Charalambous CP, Tryfonidis M, Alvi F, et al. Inter- and intraobserver variation of the Schatzker and AO/OTA classifications of tibial plateau fractures and a proposal of a new classification system. Ann R Coll Surg Engl. 2007; 89(4):400-4. doi:10.1308/003588407X187667 13. Maripuri SN, Rao P, Manoj-Thomas A, Mohanty K. The classification systems for tibial plateau fractures: how reliable are they? Injury. 2008; 39(10):1216-21. doi:10.1016/j.injury.2008.01.023 14. Gicquel T, Najihi N, Vendeuvre T, Teyssedou S, Gayet LE, Huten D. Tibial plateau fractures: reproducibility of three classifications (Schatzker, AO, Duparc) and a revised Duparc classification. Orthop Traumatol Surg Res. 2013; 99(7):805-16. doi:10.1016/j.otsr.2013.06.007 15. Walton NP, Harish S, Roberts C, Blundell C. AO or Schatzker? How reliable is classification of tibial plateau fractures? Arch Orthop Trauma Surg. 2003; 123(8):396-8. doi:10.1007/s00402- 003-0573-1 16. Millan-Billi A, Gomez-Masdeu M, Ramirez-Bermejo E, Ibanez M, Gelber PE. What is the most reproducible classification system to assess tibial plateau fractures? Int Orthop. 2017; 41(6):1251-1256. doi:10.1007/s00264-017-3462-x 17. Tuladhar R, Hu SJ, Chang SM. The articular and non-articular proportion in segment classification of tibial plateau fractures. Injury. 2019; 50(3):818-819. doi:10.1016/j.injury.2019.01.021 18. Anwar A, Zhang Y, Zhao Z, et al. Two column classification of tibial plateau fractures; description, clinical application and reliability. Injury. 2019; 50(6):1247-1255. doi:10.1016/j.injury.2019.04.021 | ||
|
آمار تعداد مشاهده مقاله: 388 تعداد دریافت فایل اصل مقاله: 464 |
||