Reproducibility of the stability-based classification for ankle fractures
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ORIGINAL ARTICLE • ANKLE - FRACT URE S
Reproducibility of the stability‑based classification for ankle fractures Bjarke Viberg1,2,3 · Tamim A. Haidari1 · Jesper Stork‑Hansen1 · Roland Knudsen1 · Rune Dueholm Bech1 Received: 21 November 2018 / Accepted: 19 February 2019 © Springer-Verlag France SAS, part of Springer Nature 2019
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. Keywords Reproducibility · Stability · Ankle fracture · Classification
Introduction Ankle fracture is a very common fracture and represents approximately 9% of all fractures with an incidence of 138169/100,000/year [1–3]. Many of these fractures are treated operatively, but there are controversies in which fracture types should be offered operative treatment [4]. There is probably a correlation between the severity of the ankle fracture and complications [5], and reliable fracture classification systems are needed for indication of operative treatment. The two most used classification systems for ankle fractures are Lauge-Hansen and AO [6, 7]. The original work of Lauge-Hansen from 1940 to 1950s describes the mechanism * Bjarke Viberg [email protected] 1
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
2
Department of Orthopaedic Surgery and Traumatology, Kolding Hospital – part of Hospital Lillebaelt, Kolding, Denmark
3
Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
of injury, while AO classifies the ankle fractures according to the position of the lateral malleolus fracture and integrity of the syndesmosis (infrasyndesmotic, transsyndesmotic, suprasyndesmotic) based on X-ray images. These two classification systems do not seem to have good reproducibility with Kappa values ranging from 0.17 to 0.48 [8–10], and the value is therefore limited. A simple and more functional approach to classify an ankle fracture is to assess the stability of the fracture. Pakarinen et al
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