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Reproducibility of the stability-based classification for ankle fractures

  • Original Article • ANKLE - FRACTURES
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Classification of ankle fracture is important when deciding for operative or conservative treatment. This study rates the reproducibility of ankle stability assessment and compares it with the classification by Lauge-Hansen and Arbeitsgemeinschaft für Osteosyntesefragen (AO) in adult patients with primary ankle fractures.

Methods

A total of 496 consecutive ankle fractures were included, and the X-ray images were reviewed 2 times by 2 medical students, 2 residents, and 1 consultant in orthopedic traumatology. The raters were blinded to each other and to their own results. Unweighted Kappa statistics were used to assess reproducibility.

Results

Overall mean (95% CI) interrater Kappa results were 0.65 (0.64; 0.68) for Lauge-Hansen, 0.62 (0.60; 0.63) for AO and 0.61 (0.57; 0.62) for the stability assessment. The intrarater results ranged from a mean Kappa of 0.64–0.80 for the medical students, 0.65–0.81 for the residents and 0.82–0.84 for the consultant.

Conclusion

The stability assessment has substantial to almost-perfect agreement which is comparable to the Lauge-Hansen and AO classifications.

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References

  1. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691

    Article  PubMed  Google Scholar 

  2. Court-Brown CM, Biant L, Bugler KE, McQueen MM (2014) Changing epidemiology of adult fractures in Scotland. Scott Med J 59(1):30

    Article  PubMed  Google Scholar 

  3. Elsoe R, Ostgaard SE, Larsen P (2018) Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg 24(1):34

    Article  PubMed  Google Scholar 

  4. Toth MJ, Yoon RS, Liporace FA, Koval KJ (2017) What’s new in ankle fractures. Injury 48(10):2035

    Article  PubMed  Google Scholar 

  5. Broos PL, Bisschop AP (1991) Operative treatment of ankle fractures in adults: correlation between types of fracture and final results. Injury 22(5):403

    Article  CAS  PubMed  Google Scholar 

  6. Lauge-Hansen N (1950) Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg 60(5):957

    Article  CAS  PubMed  Google Scholar 

  7. Müller ME, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer, Berlin

    Book  Google Scholar 

  8. Fonseca LLD, Nunes IG, Nogueira RR, Martins GEV, Mesencio AC, Kobata SI (2018) Reproducibility of the Lauge-Hansen, Danis-Weber, and AO classifications for ankle fractures. Rev Bras Ortop 53(1):101

    Article  PubMed  Google Scholar 

  9. Alexandropoulos C, Tsourvakas S, Papachristos J, Tselios A, Soukouli P (2010) Ankle fracture classification: an evaluation of three classification systems: Lauge-Hansen, A.O. and Broos-Bisschop. Acta Orthop Belg 76(4):521

    PubMed  Google Scholar 

  10. Verhage SM, Rhemrev SJ, Keizer SB, Quarles van Ufford HM, Hoogendoorn JM (2015) Interobserver variation in classification of malleolar fractures. Skelet Radiol 44(10):1435

    Article  CAS  Google Scholar 

  11. Pakarinen HJ, Flinkkil TE, Ohtonen PP, Ristiniemi JY (2011) Stability criteria for nonoperative ankle fracture management. Foot Ankle Int 32(2):141

    Article  PubMed  Google Scholar 

  12. Michelson JD (2013) Using decision analysis to assess comparative clinical efficacy of surgical treatment of unstable ankle fractures. J Orthop Trauma 27(11):642

    Article  PubMed  Google Scholar 

  13. Kottner J, Audige L, Brorson S, Donner A, Gajewski BJ, Hrobjartsson A, Roberts C et al (2011) Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. J Clin Epidemiol 64(1):96

    Article  PubMed  Google Scholar 

  14. EpiData Association. Available at: http://www.epidata.dk/. Accessed 1 Jan 2010

  15. Sim J, Wright CC (2005) The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther 85(3):257

    Article  Google Scholar 

  16. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159

    Article  CAS  Google Scholar 

  17. Cordova CB, Dunn JC, Kusnezov N, Bader JM, Waterman BR, Orr JD (2018) Comparing clinician use of three ankle fracture classifications. JAAPA 31(2):36

    Article  PubMed  Google Scholar 

  18. Thomsen NO, Overgaard S, Olsen LH, Hansen H, Nielsen ST (1991) Observer variation in the radiographic classification of ankle fractures. J Bone Joint Surg Br 73(4):676

    Article  CAS  PubMed  Google Scholar 

  19. Viberg B, Bartholin ML, Weber K, Bech RD, Palm H, Schultz-Larsen M (2016) High reliability of a scoring system for implant position in undisplaced femoral neck fractures. J Orthop Trauma 30(8):432

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark

    Bjarke Viberg, Tamim A. Haidari, Jesper Stork-Hansen, Roland Knudsen & Rune Dueholm Bech

  2. Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt, Kolding, Denmark

    Bjarke Viberg

  3. Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark

    Bjarke Viberg

Authors
  1. Bjarke Viberg
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  2. Tamim A. Haidari
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  3. Jesper Stork-Hansen
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  4. Roland Knudsen
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  5. Rune Dueholm Bech
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Correspondence to Bjarke Viberg.

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Viberg, B., Haidari, T.A., Stork-Hansen, J. et al. Reproducibility of the stability-based classification for ankle fractures. Eur J Orthop Surg Traumatol 29, 1125–1129 (2019). https://doi.org/10.1007/s00590-019-02404-8

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  • DOI: https://doi.org/10.1007/s00590-019-02404-8

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