Skip to main content

Advertisement

SpringerLink
Log in

The intra- and interobserver reliability of the Tile AO, the Young and Burgess, and FFP classifications in pelvic trauma

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Several different systems of classification have been developed to understand the complexity of pelvic ring fractures, to facilitate communication between physicians and to support the selection of appropriate therapeutic measures. The purpose of this study was to measure the inter- and intraobserver reliability of Tile AO, Young and Burgess, and FFP classification in pelvic ring fractures. The Rommens classification system (FFP) is analyzed for the first time.

Materials and methods

Four reviewers (2 × senior pelvic trauma surgeon, 1 × resident, 1 × medical student) separately analyzed and classified 154 CT scans of patients with pelvic fracture. The Tile AO, the Young and Burgess, and the FFP classifications (subgroup with patients ≥ 60 years) were compared. Another blinded re-evaluation was carried out after 2 months to determine intraobserver reliability.

Results

The overall interobserver agreement was fair for all classification systems (ICC: OTA 0.55, Young and Burgess 0.42, FFP 0.54). For specific categories, (e.g. type B or C fractures), there was a substantial agreement between the experienced surgeons (kappa: OTA 0.64, Young and Burgess 0.62, FFP 0.68). For inexperienced observers, there was a fair agreement in all systems (kappa: OTA 0.23, Young and Burgess 0.23, FFP 0.36).

Conclusions

All three classifications reach their maximum reliability with advanced expertise in the surgery of pelvic fractures. The novel FFP classification has proved to be at least equivalent when directly compared to the established systems. The FFP classification system showed substantial reliability in patients older than 60 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Buller LT, Best MJ, Quinnan SM (2016) A nationwide analysis of pelvic ring fractures: incidence and trends in treatment, length of stay, and mortality. Geriatr Orthop Surg Rehabil 7:9–17. https://doi.org/10.1177/2151458515616250

    Article  Google Scholar 

  2. Pereira GJC, Damasceno ER, Dinhane DI et al (2017) Epidemiology of pelvic ring fractures and injuries. Rev Bras Ortop 52:260–269. https://doi.org/10.1016/j.rboe.2017.05.012

    Article  Google Scholar 

  3. Kannus P, Parkkari J, Niemi S, Sievänen H (2015) Low-trauma pelvic fractures in elderly finns in 1970–2013. Calcif Tissue Int 97:577–580. https://doi.org/10.1007/s00223-015-0056-8

    Article  Google Scholar 

  4. Krappinger D, Kammerlander C, Hak DJ, Blauth M (2010) Low-energy osteoporotic pelvic fractures. Arch Orthop Trauma Surg 130:1167–1175. https://doi.org/10.1007/s00402-010-1108-1

    Article  Google Scholar 

  5. Studer P, Suhm N, Zappe B et al (2013) Pubic rami fractures in the elderly–a neglected injury? Swiss Med Wkly 143:w13859. https://doi.org/10.4414/smw.2013.13859

    Google Scholar 

  6. Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E (2003) Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Jt Bone Spine 70:287–289

    Article  Google Scholar 

  7. Yang N-P, Chan C-L, Chu D et al (2014) Epidemiology of hospitalized traumatic pelvic fractures and their combined injuries in Taiwan: 2000–2011 National Health Insurance data surveillance. Biomed Res Int 2014:878601. https://doi.org/10.1155/2014/878601

    Google Scholar 

  8. Tile M (1996) Acute pelvic fractures: I. causation and classification. J Am Acad Orthop Surg 4:143–151

    Article  Google Scholar 

  9. Marsh JL, Slongo TF, Agel J et al Fracture and dislocation classification compendium—2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21:S1-133

  10. Young JW, Burgess AR, Brumback RJ, Poka A (1986) Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160:445–451. https://doi.org/10.1148/radiology.160.2.3726125

    Article  Google Scholar 

  11. Rommens PM, Hofmann A (2013) Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 44:1733–1744. https://doi.org/10.1016/j.injury.2013.06.023

    Article  Google Scholar 

  12. Gabbe BJ, Esser M, Bucknill A et al (2013) The imaging and classification of severe pelvic ring fractures: experiences from two level 1 trauma centres. Bone Jt J 95–B:1396–1401. https://doi.org/10.1302/0301-620X.95B10.32134

    Article  Google Scholar 

  13. Furey AJ, O’Toole RV, Nascone JW et al (2009) Classification of pelvic fractures: analysis of inter- and intraobserver variability using the Young–Burgess and tile classification systems. Orthopedics 32:401. https://doi.org/10.3928/01477447-20090511-05

    Article  Google Scholar 

  14. Koo H, Leveridge M, Thompson C et al (2008) Interobserver reliability of the young–burgess and tile classification systems for fractures of the pelvic ring. J Orthop Trauma 22:379–384. https://doi.org/10.1097/BOT.0b013e31817440cf

    Article  Google Scholar 

  15. Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46. https://doi.org/10.1177/001316446002000104

    Article  Google Scholar 

  16. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  Google Scholar 

  17. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428

    Article  Google Scholar 

  18. Cicchetti DV, Sparrow SA (1981) Developing criteria for establishing interrater reliability of specific items: applications to assessment of adaptive behavior. Am J Ment Defic 86:127–137

    Google Scholar 

Download references

Funding

There is no funding source.

Author information

Author notes

  1. Josephine Berger-Groch and Darius M. Thiesen contributed equally and, therefore, share first authorship.

Authors and Affiliations

  1. Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Josephine Berger-Groch, Darius M. Thiesen, Jan Schaewel, Florian Fensky & Maximilian J. Hartel

  2. Department of Orthopedics, Trauma-and Spine Surgery, Asklepios Hospital Hamburg-Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Germany

    Lars G. Grossterlinden

Authors
  1. Josephine Berger-Groch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Darius M. Thiesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lars G. Grossterlinden
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Schaewel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Florian Fensky
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maximilian J. Hartel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Josephine Berger-Groch.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures involving human participants were in accordance with the ethical standards of the institutional and national research committee (reference number: WF-009/18) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 611 KB)

Supplementary material 2 (XLSX 18 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berger-Groch, J., Thiesen, D.M., Grossterlinden, L.G. et al. The intra- and interobserver reliability of the Tile AO, the Young and Burgess, and FFP classifications in pelvic trauma. Arch Orthop Trauma Surg 139, 645–650 (2019). https://doi.org/10.1007/s00402-019-03123-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-019-03123-9

Keywords

Search

Navigation