Classification of distal radius fractures: An analysis of interobserver reliability and intraobserver reproducibility

Andersen, D; Blair, W. Frank; Stevers, Curtis M.; Adams, Brian D.; El-Khouri, George Y.; Brandser, Eric A.

doi:10.1016/s0363-5023(96)80006-2

Cited by 187 publications

(134 citation statements)

References 18 publications

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“…The Universal classification system can be easily memorized, is deductive, and applicable to any fracture, yet there are few studies on its reproducibility. In our study, we observed poor to moderate agreement for the Universal classification system and poor agreement for the AO classification system after the inclusion of tomograms in the second phase, as shown by the low kappa coefficient values obtained-the same as described by several authors comparing the phases relying solely on radiographic images [2,8,11,16,20].…”

Section: Discussionsupporting

confidence: 66%

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: Discussionsupporting

confidence: 66%

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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“…In a multi-layer classification scheme it is expected that the agreement rates decrease in subsequent levels, as observed for the AO classification of peripheral fractures [1,2,3,5,10,11,13,14,20,21,27,29,31]. This does not seem to be the case in the classification scheme we studied.…”

Section: Figmentioning

confidence: 68%

Classification of thoracic and lumbar spine fractures: problems of reproducibility

Oner¹,

et al. 2002

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“…This rating system has been used to defi ne surgical fi xation methods, but its accuracy and reproducibility for identifying the four fragments on conventional x-rays have not been validated yet by clinical trials, and the system still presents disagreements. 10 The Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) rating system was created in 1986 and reviewed in 1990. It considers bone injury severity and is a basis for treatment and results evaluation.…”

Section: Introductionmentioning

confidence: 99%

Are distal radius fracture classifications reproducible? Intra and interobserver agreement

et al. 2008

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CONTEXT AND OBJECTIVE: Various classifi cation systems have been proposed for fractures of the distal radius, but the reliability of these classifications is seldom addressed. For a fracture classification to be useful, it must provide prognostic signifi cance, interobserver reliability and intraobserver reproducibility. The aim here was to evaluate the intraobserver and interobserver agreement of distal radius fracture classifi cations. DESIGN AND SETTING:This was a validation study on interobserver and intraobserver reliability. It was developed in the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo -Escola Paulista de Medicina.METHOD: X-rays from 98 cases of displaced distal radius fracture were evaluated by fi ve observers: one third-year orthopedic resident (R3), one sixth-year undergraduate medical student (UG6), one radiologist physician (XRP), one orthopedic trauma specialist (OT) and one orthopedic hand surgery specialist (OHS). The radiographs were classifi ed on three different occasions (times T1, T2 and T3) using the Universal (Cooney), Arbeitsgemeinschaft für Osteosynthesefragen/ Association for the Study of Internal Fixation (AO/ASIF), Frykman and Fernández classifi cations. The kappa coeffi cient (κ) was applied to assess the degree of agreement. RESULTS:Among the three occasions, the highest mean intraobserver k was observed in the Universal classifi cation (0.61), followed by Fernández (0.59), Frykman (0.55) and AO/ASIF (0.49). The interobserver agreement was unsatisfactory in all classifi cations. The Fernández classifi cation showed the best agreement (0.44) and the worst was the Frykman classifi cation (0.26). CONCLUSION:The low agreement levels observed in this study suggest that there is still no classifi cation method with high reproducibility.

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Classification of distal radius fractures: An analysis of interobserver reliability and intraobserver reproducibility

Cited by 187 publications

References 18 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

Classification of thoracic and lumbar spine fractures: problems of reproducibility

Are distal radius fracture classifications reproducible? Intra and interobserver agreement

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