Intrarater and Inter-rater Reliability of Tibial Plateau Fracture Classifications

Background: The interobserver and intraobserver reliability of various tibial plateau fracture (TPF) classifications has been examined in recent literature using radiography, computed tomography, and magnetic resonance imaging. The question remains as to which classification system provides the highest reliability. In this systematic review, we are going to evaluate the overall interobserver and intraobserver reliability of various TPF classifications in different imaging modalities. Methods: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In February 2023, predefined terms were used for database search (Embase, PubMed, Scopus, Cochrane, and Web of Science). Meta-analysis of intrarater and inter-rater kappa coefficients was performed for each of the classifications in each modality. Results: Thirty-four studies were included in this review. Schatzker's classification was more frequently used than others. It had a better intrarater kappa coefficient than the Hohl and Moore and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classifications in radiography (κ = 0.72, 95% confidence interval CI = 0.67-0.76, p < 0.01). The Schatzker and AO/OTA classifications had similar inter-rater reliability in the radiography modality (κ = 0.53, 95% CI = 0.51-0.54, p < 0.01; κ = 0.53, 95% CI = 0.5-0.55, p < 0.01; respectively). In 3-dimensional computed tomography, the Luo classification system showed the highest intrarater (κ = 0.85, 95% CI = 0.35-0.66) and inter-rater (κ = 0.77, 95% CI = 0.73-0.81) kappa coefficients. Conclusion: Three-column classification proposed by Luo et al. was able to reach the highest degree and was the only classification with near-excellent inter-rater reliability.