Interobserver variation in classification of malleolar fractures

Verhage, Samuël Marinus; Rhemrev, Steven J.; Keizer, Stefan B.; Ufford, Henriëtte Quarles van; Hoogendoorn, J. M.

doi:10.1007/s00256-015-2179-4

Cited by 20 publications

(13 citation statements)

References 26 publications

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“…Another important limitation concerns the measurement of posterior malleolar fragment size on lateral preoperative X-rays and the measurement of postoperative step-off on lateral X-rays. Some articles that were published in the last few years have reported that the interobserver agreement of fragment size on lateral X-rays is poor [29, 30] and even CT-scanning is not reliable to compare different fragment sizes [22, 23]. Therefore, the possible relation between fragment size and functional outcome may have been missed in our study because of inaccurate measurements.…”

Section: Discussionmentioning

confidence: 86%

Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures

Verhage

Krijnen

Schipper

et al. 2018

Arch Orthop Trauma Surg

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Background Traditionally, size of the posterior fragment is considered the most important indicator for fixation in trimalleolar fractures. It remains unclear which factors contribute to worse functional and radiological outcome. This study was designed to determine predictors for the development of posttraumatic osteoarthritis and worse functional outcome in trimalleolar fractures. Methods This retrospective cohort study evaluated outcomes of 169 patients with a trimalleolar fracture treated between 1996 and 2013 in a level-1 trauma hospital in the Netherlands after a mean follow-up of 6.3 (range 2.4 to 15.9) years. The average fragment size was 17%. Twenty patients had a posterior fragment smaller than 5% of the intra-articular surface, 119 patients a fragment of 5–25% and 30 patients a posterior fragment larger than 25%. In total, 39 patients (23%) underwent fixation of the posterior fragment. Results Clinical union was achieved in all 169 patients. The median AOFAS score after follow-up was 93 (interquartile range 76–100) and the median AAOS score was 92 (interquartile range 81–98). A persistent postoperative step-off larger than 1 mm was found in 65 patients (39%) and osteoarthritis was present in 49 patients (30%). Higher age and postoperative step-off > 1 mm were independent, significant risk factors for the development of osteoarthritis. Osteoarthritis and BMI were independent, significant risk factors for worse functional outcome. Conclusion It is advisable to correct intra-articular step-off of intraarticular posterior malleolar fragments to reduce the risk of developing osteoarthritis and, consequently, the risk of worse functional outcome after long-term follow-up. Level of evidence Level IIB.

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Section: Discussionmentioning

confidence: 86%

Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures

Verhage

Krijnen

Schipper

et al. 2018

Arch Orthop Trauma Surg

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“…Future studies should only use CT scans when assessing articular congruency. 16 Another limitation is that only trimalleolar fractures which were fixed using a posterolateral approach are included. There are no data available on unfixed posterior malleolar fragments or those treated with 'anterior to posterior' percutaneous fixation.…”

Section: Discussionmentioning

confidence: 99%

Open reduction and internal fixation of posterior malleolar fractures using the posterolateral approach

Verhage

Boot

Schipper

et al. 2016

The Bone & Joint Journal

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“…Na literatura encontramos trabalhos que avaliaram a variação na classificação intra e entre observadores das fraturas de tornozelo. 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) .…”

Section: Discussionunclassified

“…O grande problema da classificação de Lauge-Hansen é que em muitos casos não se consegue, ao certo, concluir o mecanismo de trauma que gerou a fratura (26) . As classificações de Danis-Weber e AO-OTA têm como dificuldades a definição da posição da sindesmose tibiofibular e a impossibilidade de classificação das também fraturas isoladas do maléolo medial (23) . A classificação da AO-OTA não é muito utilizada na prática clínica, por apresentar muitos subtipos (9 possibilidades) o que dificulta sua memorização e utilização no contexto de unidades de urgência/emergência.…”

Section: Discussionunclassified

Concordance analysis of adult ankle fracture classifications

et al. 2019

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Objective: To analyze the interobserver agreement among physicians in an orthopedy and traumatology service with knowledge and training in adult ankle fracture classifications through radiographic evaluation. Methods: A cross-sectional study was carried out in which the records of 20 patients with a diagnosis of ankle fracture in 2016 (uni-, bi- or trimalleolar), aged older than 18 years or with a closed physis, were studied. The radiographs that met the criteria were analyzed and classified according to the Danis Weber (DW), Lauge-Hansen (LH) and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classifications by two first-year residents, two second-year residents, two third-year residents and two preceptors of the service. The conditions were identical for the observers and were performed individually once. The Kappa coefficient (K) was used to assess agreement. Results: The results showed great interobserver agreement in the DW and LH classifications, with K values equal to 0.69 and 0.64, respectively. The AO/OTA classification showed moderate agreement, with K = 0.47. Conclusion: The DW classification was the most reliable among the three classifications. The AO/OTA classification showed the lowest agreement and was the least reliable, and the LH classification was in between the others. Level of Evidence III, Diagnostic Studies; Study of non consecutive patients; without consistently applied reference “gold” standard.

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Interobserver variation in classification of malleolar fractures

Cited by 20 publications

References 26 publications

Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures

Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures

Open reduction and internal fixation of posterior malleolar fractures using the posterolateral approach

Concordance analysis of adult ankle fracture classifications

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