Reproducibility of the Lauge-Hansen, Danis-Weber, and AO classifications for ankle fractures

Abstract

ObjectiveThis study evaluated the reproducibility of the three main classifications of ankle fractures most commonly used in emergency clinical practice: Lauge-Hansen, Danis-Weber, and AO-OTA. The secondary objective was to assess whether the level of professional experience influenced the interobserver agreement for the classification of this pathology.MethodsThe study included 83 digitized preoperative radiographic images of ankle fractures, in anteroposterior and lateral views, of different adults that had occurred between January and December 2013. For sample calculation, the estimated accuracy was approximately 15%, with a sampling error of 5% and a sampling power of 80%. The images were analyzed and classified by six different observers: two foot and ankle surgeons, two general orthopedic surgeons, and two-second-year residents in orthopedics and traumatology. The Kappa statistical method of multiple variances was used to assess the variations.ResultsThe Danis-Weber classification indicated that 40% of the agreements among all observers were good or excellent, whereas only 20% of good and excellent agreements were obtained using the AO and Lauge Hansen classifications. The Kappa index was 0.49 for the Danis-Weber classification, 0.32 for Lauge Hansen, and 0.38 for AO.ConclusionThe Hansen-Lauge classification presented the poorest interobserver agreement among the three systems. The AO classification demonstrated a moderate agreement and the Danis-Weber classification presented an excellent interobserver agreement index, regardless of professional experience.

Biomechanics of Osteoporotic Fracture Fixation

“…When combined with comorbidities such as diabetes and obesity, the post-operative risk of nonunion is increased and makes fracture treatment challenging [50-52•,53,54]. Ankle fractures are classified according to Danis-Weber type A, B, or C for the lateral malleolus [55,56] and AO 43 for the distal tibia and fibula [57]. Non-operative treatment with a cast is only considered to be an option in cases of stable and non-displaced fractures, including isolated medial malleolar or isolated fibular fractures without syndesmotic rupture or instability [58][59][60].…”

Concordance analysis of adult ankle fracture classifications

“…Todos os estudos encontrados utilizaram o coeficiente Kappa para a análise da concordância, mostrando-se o mais confiável para se fazer a pesquisa (18)(19)(20)(21)(22)(23) . Na literatura brasileira foram encontrados quatro estudos que fizeram uma análise semelhante (7,12,24,25) .…”

“…Devido principalmente a esses fatores observa-se diferentes interpretações nas classificações citadas. O uso rotineiro das classificações, aliado ao tempo, diminui consideravelmente os erros no momento da classificação (24) .…”

“…Um estudo descoberto na literatura que comparou as três classificações obteve resultados ligeiramente diferentes, descobrindo uma reprodutibilidade moderada para todas as classificações, (Weber (K=0.49), AO (K=0.45) e Lauge-Hansen (K=0.47). A diferença pode ser devida ao número maior de casos analisados (100), sendo que apenas quatro observadorestinham uma formação acadêmica semelhante (24) . O estudo apresentou algumas limitações, como a pequena casuística, a não randomização e a não separação por grupos de acordo com a formação acadêmica.…”

Management of trimalleolar fracture in Sanglah hospital: a case series

“…This classification disregards the state of the structures on the medial side, a vital osteoligament structure, and it is not possible to compare prognosis, treatment, or evolution of the pathology with this classification alone. 6 The diagnosis of the ankle fracture is determined using a combination of the patient's history, physical examination, and radiographic evaluation. Patients with an ankle fracture will present acute deformities, swelling (especially perimalleolar), bony tenderness, discoloration, ecchymosis, open wounds, the overall soft tissue condition and neurovascular status of the injured limb.…”