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

Document Type : RESEARCH PAPER


1 Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India

2 Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Jodhpur, India

3 Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Jodhpur, India

4 All India Institute of Medical Sciences (AIIMS), Jodhpur, India

5 Department. of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Jodhpur, India


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 
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


Main Subjects

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