Abstract
Purpose: To evaluate the intra and inter-observer variation of the Schatzker and AO/OTA classifications in assessing tibial plateau fractures, using plain radiographs.
Summary: Fifty tibial plateau fractures were classified independently by 6 observers as per the Schatzker and AO/OTA classifications, using antero-posterior and lateral plain radiographs. Assessment was done on two occasions 8 weeks apart.
We found that both the Schatzker and AO/OTA classifications have a high intra-observer (kappa=0.57 and 0.53 respectively), and inter-observer (kappa=0.41 and 0.43 respectively) variation. Classification of tibial plateau fractures into unicondylar vs. bicondylar and pure splits vs. articular depression +/− split conferred improved inter and intra-observer variation.
Conclusions: The high inter-observer variation found for the Schatzker and AO/OTA classifications must be taken into consideration when these are used as a guidance of treatment and when used in evaluating patients’ outcome. Simply classifying tibial plateau fractures into unicondylar vs. bicondylar and pure splits vs. articular depression +/− split may be more reliable.
Correspondence should be addressed to Mr T Wilton, c/o BOA, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
