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Skeletal Radiology

, Volume 44, Issue 10, pp 1435–1439 | Cite as

Interobserver variation in classification of malleolar fractures

  • S. M. VerhageEmail author
  • S. J. Rhemrev
  • S. B. Keizer
  • H. M. E. Quarles van Ufford
  • J. M. HoogendoornEmail author
Scientific Article

Abstract

Objective

Classification of malleolar fractures is a matter of debate. In the ideal situation, a classification system is easy to use, shows good inter- and intraobserver agreement, and has implications for treatment or research.

Material and methods

Interobserver study. Four observers distributed 100 X-rays to the Weber, AO and Lauge-Hansen classification. In case of a trimalleolar fracture, the size of the posterior fragment was measured. Interobserver agreement was calculated with Cohen’s kappa. Agreement on the size of the posterior fragment was calculated with the intraclass correlation coefficient.

Results

Moderate agreement was found with all classification systems: the Weber (K = 0.49), AO (K = 0.45) and Lauge-Hansen (K = 0.47). Interobserver agreement on the presence of a posterior fracture was substantial (K = 0.63). Estimation of the size of the fragment showed moderate agreement (ICC = 0.57).

Conclusion

Classification according to the classical systems showed moderate interobserver agreement, probably due to an unclear trauma mechanism or the difficult relation between the level of the fibular fracture and syndesmosis. Substantial agreement on posterior malleolar fractures is mostly due to small (<5 %) posterior fragments. A classification system that describes the presence and location of fibular fractures, presence of medial malleolar fractures or deep deltoid ligament injury, and presence of relevant and dislocated posterior malleolar fractures is more useful in the daily setting than the traditional systems. In case of a trimalleolar fracture, a CT scan is in our opinion very useful in the detection of small posterior fragments and preoperative planning.

Keywords

Radiological classification Malleolar fractures Ankle fractures Trimalleolar fractures Posterior malleolar fracture 

Notes

Conflicts of interest

No conflicts of interest were declared for all authors.

Source of funding

No funding was necessary to complete this study.

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Copyright information

© ISS 2015

Authors and Affiliations

  • S. M. Verhage
    • 1
    • 4
    Email author
  • S. J. Rhemrev
    • 1
  • S. B. Keizer
    • 2
  • H. M. E. Quarles van Ufford
    • 3
  • J. M. Hoogendoorn
    • 1
    • 4
    Email author
  1. 1.Department of SurgeryMC HaaglandenThe HagueThe Netherlands
  2. 2.Department of Orthopaedic SurgeryMC HaaglandenThe HagueThe Netherlands
  3. 3.Department of RadiologyMC HaaglandenThe HagueThe Netherlands
  4. 4.MC Haaglanden, locatie WesteindeSecretariaat HeelkundeThe HagueThe Netherlands

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