Four distal radial fracture classification systems tested amongst a large panel of Dutch trauma surgeons

Five different radiographs of distal radial fractures were classified according to the AO/ASIF, Frykman, Fernandez and Older systems by 45 observers (trauma surgeons and residents). The same panel classified the same radiographs in a different order 4 months later. Mean interobserver correlation for all cases was fair to moderate according to the Spearman rank test. However, these classifications showed poor correlation with the gold standard as classified by the senior author. All intraobserver agreements demonstrated a moderate kappa agreement (K(w)=0.52) for the AO/ASIF classification and fair for the Frykman (K(w)=0.26), Fernandez (K(w)=0.24) and Older (K(w)=0.27) classifications. When the group was divided according to years of clinical experience (<6 years; >or=6 years), there was poor correlation between experience and consistency amongst all four classifications. In view of these findings, we do not recommend use of these classifications for clinical application because of their questionable reproducibility and reliability.