The IDEAL classification system: a new method for classifying fractures of the distal extremity of the radius description and reproducibility

Belloti, João Carlos; Santos, João Baptista Gomes dos; Moraes, Vinícius Ynoe de; Wink, Felipe Vitiello; Tamaoki, Marcel Jun Sugawara; Faloppa, Flávio

doi:10.1590/1516-3180.2013.1314496

Cited by 11 publications

(8 citation statements)

References 26 publications

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“…There exist, however, few studies correlating CT usage with the institution where care is provided [4, 15]. There are only a few studies comparing residents, specialists in orthopedics, traumatology, and hand surgery in terms of classification of fractures and indications for treatment [3, 5, 7, 13]. Only one of them used CT scans.…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography's Influence on the Classifications and Treatment of the Distal Radius Fractures

Nascimento¹,

Costa²,

Falcochio³

et al. 2015

Hand (New York, N,Y.)

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Introduction Distal radius fractures are common in emergency centers. The radiographic routine includes at least two radiographic projections used for diagnosing most of these fractures. Computed tomography (CT) is indicated for evaluating complex fractures that affect the articular surface, as well as the fragments' size and position. There are not enough comparative studies on choosing classification and treatment by means of the four radiographic projections and computed tomography (CT) and the association of these with the levels of expertise. Methods We conducted a randomized cross-sectional study by observing images from 61 patients with distal radius fractures organized in two phases: the first phase comprising radiographic images alone and the second one with those same images associated with tomograms. Seventeen evaluators with different levels of training and expertise classified the fractures according to the AO and Universal classification systems and proposed treatment guidelines. Results The agreement between the AO and Universal classification ratings was poor (worse for the former), with smaller Fleiss' kappa resulting from data obtained by orthopedics residents and non-specialist orthopedists. CT influenced the classification choice, with a higher change frequency for more complex patterns in the AO classification system and intraarticular and irreducible fractures in the Universal classification system, especially in the group comprised of orthopedic residents and orthopedic physicians. CT did not influence the treatment choice made by the group comprised of hand surgery residents and hand surgeons. Conclusion The less experienced in hand surgery the observer was, the more important computed tomography was for determining the fracture pattern.

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Section: Introductionmentioning

confidence: 99%

Computed Tomography's Influence on the Classifications and Treatment of the Distal Radius Fractures

Nascimento¹,

Costa²,

Falcochio³

et al. 2015

Hand (New York, N,Y.)

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“…Two classifications will be utilized, the Arbeitsgemeinschaft für Osteosynthesefragen–Association for the Study of Internal Fixation (AO-ASIF) classification [23,24] and the “IDEAL” classification [25], which consists of the following (Table 1):…”

Section: Methodsmentioning

confidence: 99%

Treatment of reducible unstable fractures of the distal radius: randomized clinical study comparing the locked volar plate and external fixator methods: study protocol

Neto

Moraes

Santos

et al. 2014

BMC Musculoskelet Disord

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BackgroundVarious treatments are available for reducible unstable fractures of the distal radius, such as closed reduction combined with fixation by external fixator (EF), and rigid internal fixation using a locked volar plate (VP). Although there are studies comparing these methods, there is no conclusive evidence indicating which treatment is best. The hypothesis of this study is that surgical treatment with a VP is more effective than EF from the standpoint of functional outcome (patient-reported).Methods/DesignThe study is randomized clinical trial with parallel groups and a blinded evaluator and involves the surgical interventions EF and VP. Patients will be randomly assigned (assignment ratio 1:1) using sealed opaque envelopes. This trial will include consecutive adult patients with an acute (up to 15 days) displaced, unstable fracture of the distal end of the radius of type A2, A3, C1, C2 or C3 by the Arbeitsgemeinschaft für Osteosynthesefragen–Association for the Study of Internal Fixation classification and type II or type III by the IDEAL32 classification, without previous surgical treatments of the wrist. The surgical intervention assigned will be performed by three surgical specialists familiar with the techniques described. Evaluations will be performed at 2, and 8 weeks, 3, 6 and 12 months, with the primary outcomes being measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and measurement of pain (Visual Analog Pain Scale and digital algometer). Secondary outcomes will include radiographic parameters, objective functional evaluation (goniometry and dynamometry), and the rate of complications and method failure according to the intention-to-treat principle. Final postoperative evaluations (6 and 12 months) will be performed by independent blinded evaluators. For the Student’s t-test, a difference of 10 points in the DASH score, with a 95% confidence interval, a statistical power of 80%, and 20% sampling error results in 36 patients per group.DiscussionResults from this study protocol will improve the current evidence regarding to the surgical treatment these fractures.Trial registrationISCRTN09599740

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“…A score of 2-3 was a potentially unstable fracture and K-needle, external xation or internal xation was used. A score of 4-5 was a complex fracture that required multiple methods and bone grafting [24].…”

Section: Recent Research On New Typing System For Distal Radiusmentioning

confidence: 99%

“…In view of the low reproducibility of the classi cation of distal radius fractures, Bellott et al proposed an IDEAL classi cation method based on epidemiological and imaging factors [24]. According to the patient's age, epidemiological factors of trauma energy, degree of bone mass displacement, joint integrity, and imageology factors with injuries, scores were classi ed.…”

Section: Recent Research On New Typing System For Distal Radiusmentioning

confidence: 99%

ABC Classification System ： Establishment and Preliminary Evaluation of CT-based Classification for Distal Radius Fracture

Zhang

Yao

Song

et al. 2023

Preprint

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Objective Establish a new classification system of distal radius fracture based on computed tomographic (CT), and evaluate its reliability and reproducibility preliminarily, and provide a new theoretical reference for clinicians to use the clinical classification system. Methods The imaging data and clinical data of 204 inpatients with distal radius fractures during 6 years from January 1, 2014 to January 1, 2019 in orthopaedic department were analyzed retrospectively and classified based on CT. Three observers evaluated the image data of 48 randomly selected cases based on CT at different time nodes of T1 and T2. Cohen's kappa was used to calculate the consistency. Results Among 204 cases, there were 12 cases of type A, including 6 cases of type A1, 4 cases of type A2 and 2 cases of type A3. There were 6 cases of type B, including 2 cases of type B1, 2 cases of type B2 and 2 cases of type B3. There were 186 cases of type C, including 32 cases of type C1, 127 cases of type C2 and 27 cases of type C3. There was no significant difference in Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation(PRWE) and VAS scores among all types (P > 0.05). The results of interobserver reproducibility were kappa = 0.985, ICC = 0.984 in the first evaluation, kappa = 0.986, ICC = 0.986 in the second evaluation. The results of intraobserver reproducibility were O1 = 0.991, O2 = 0.991, O3 = 0.989 respectively. Conclusions The new classification system of distal radius fracture based on CT has theoretical and practical significance for incision selection, fracture reduction and internal fixation. ABC typing system is clear, comprehensive, easy to understand and remember. Moreover, it has higher interobserver reliability and intraobserver reproducibility than other systems reported at present.

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The IDEAL classification system: a new method for classifying fractures of the distal extremity of the radius description and reproducibility

Cited by 11 publications

References 26 publications

Computed Tomography's Influence on the Classifications and Treatment of the Distal Radius Fractures

Computed Tomography's Influence on the Classifications and Treatment of the Distal Radius Fractures

Treatment of reducible unstable fractures of the distal radius: randomized clinical study comparing the locked volar plate and external fixator methods: study protocol

ABC Classification System ： Establishment and Preliminary Evaluation of CT-based Classification for Distal Radius Fracture

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