ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2023
The influence of 3D printing on inter- and intrarater reliability on the classification of tibial plateau fractures.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Comparison of virtual reality and computed tomography in the preoperative planning of complex tibial plateau fractures.Archives of orthopaedic and trauma surgery · 2024Trial
- Lecture, model, or both? Optimizing fracture education with 3D printing: a longitudinal interventional study.3D printing in medicine · 2026Article
- Mixed reality improves agreement on surgical approach selection and patient positioning in tibial plateau fracture planning compared to CT, 3DCT and 3D printing.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Mixed reality enhances interobserver reliability in tibial plateau fracture classification compared to computed tomography, 3D computed tomography and 3D printing.Journal of experimental orthopaedics · 2025Article
- Assessment of proximal tibial fractures with 3D FRACTURE (fast field echo resembling a CT using restricted echo-spacing) MRI-intra-individual comparison with CT.European radiology · 2025Article
- 3D printing improves preoperative decision making for patient positioning and surgical approach selection for tibial plateau fractures.Scientific reports · 2025Article
- [3D printing/implants in traumatology].Unfallchirurgie (Heidelberg, Germany) · 2025Review
- Lack of standardisation in the management of complex tibial plateau fractures: a multicentre experience.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Article
- Mayo classification of olecranon fractures revisited - Assessment of intra- and interobserver reliability based on CT scans.Journal of orthopaedics · 2024Article
- The Clinical Efficacy of Contouring Periarticular Plates on a 3D Printed Bone Model.Journal of personalized medicine · 2023Article
- Preoperative Mixed-Reality Visualization of Complex Tibial Plateau Fractures and Its Benefit Compared to CT and 3D Printing.Journal of clinical medicine · 2023Article
- The Use of 3D Printing as an Educational Tool in Orthopaedics.JB & JS open accessReview
- Intrarater and Inter-rater Reliability of Tibial Plateau Fracture Classifications: Systematic Review and Meta-Analysis.JB & JS open accessReview
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Authors and funding
10 authors.
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Abstract
purposeTibial plateau fractures continue to be a challenging task in clinical practice and current outcomes seem to provide the potential for further improvement. Especially presurgical understanding of the orientation of fracture lines and fracture severity is an essential key to sufficient surgical treatment. The object of this study was to evaluate the reliability of modern axial CT-based classification systems for tibial plateau fractures. In addition, the diagnostic-added value of 3D printing on the classification systems was investigated.
methods22 raters were asked to classify 22 tibial plateau fractures (11 AO B- and 11 AO C-fractures) with the AO, the 10-Segment and the Revisited Schatzker classification in a three-step evaluation: first only using CT scans, second with 3D volumetric reconstructions and last with 3D-printed fracture models. Inter- and intraobserver agreement and the subjective certainty were analyzed. Statistics were done using kappa values, percentage match and a univariant one-way analysis of variance.
resultsThe AO classifications interobserver percentage match and kappa values improved for all raters and recorded an overall value of 0.34, respectively, 43% for the 3D print. The 10-Segment classification interobserver agreement also improved with the 3D-printed models and scored an overall kappa value of 0.18 and a percentage match of 79%. Equally the Revisited Schatzker classification increased its values to 0.31 and 35%. The intraobserver agreement showed a moderate agreement for the AO (0.44) and Revisited Schatzker classification (0.42) whereas the 10-Segment classification showed a fair agreement (0.27). Additionally, the raters changed their classification in 36% of the cases after evaluating the fracture with the 3D-printed models and the subjective certainty regarding the decisions improved as categories of self-reliant diagnostic choices were selected 18% (p < 0.05) more often after using the 3D-printed models.
conclusionBased on the measured outcomes it was concluded that the new classification systems show an overall slight to fair reliability and the use of 3D printing proved to be beneficial for the preoperative diagnostics of tibial plateau fractures. The 10-Segment classification system showed the highest percentage match evaluation of all classification systems demonstrating its high clinical value across all levels of user experience.
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