IMPACT OF CT SCAN ON TREATMENT PLAN AND FRACTURE CLASSIFICATION OF TIBIAL PLATEAU FRACTURES

Objective: To evaluate the interobserver and intraobserver agreement f or bath treatment plan and fracture classification of tibial plateau f ractures using plain films alone and with computed tomography (CT) sca ns. Design: Prospective study to assess the impact of an advanced radi ologic study on the agreement of treatment plan and fracture classific ation of tibial plateau fractures. Setting/Participants: Two orthopaed ic traumatologists, two orthopaedic residents, and two skeletal radiol ogists were presented with twenty-one cases of tibial plateau fracture s imaged with plain films and with CT scans. Main Outcome Measures: Ag reement was measured using kappa coefficients. Results: Using plain fi lms alone, the mean interobserver kappa coefficient for classification was 0.62, which decreased to 0.61 after addition of CT scans. Using p lain films alone for formulating a treatment plan, the mean interobser ver kappa. coefficient was 0.58, which increased to 0.71 after additio n of CT scans. The mean intraobserver kappa coefficient for fracture c lassification using plain films was 0.70, which increased to 0.80 with addition of CT scans. The mean intraobserver kappa coefficient for tr eatment plan based on plain films alone was 0.62, which increased to 0 .82 after addition of CT scans. Class was changed in an average of 12 percent of cases after addition of CT scans. Treatment plan was change d an average of 26 percent of the time after addition of CT scans. Con clusion: Addition of CT scans to plain roentgenograms increases the in terobserver and intraobserver agreement on treatment plan.