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Total talar fracture - inter- and intra-observer reproducibility of two classification systems (Hawkins and AO) for
T Williams1, N Barba, T Noailles
1Service de chirurgie orthopédique, hôpital de Cavale-Blanche, CHU, boulevard Tanguy-Prigent, 29200 Brest cedex, France.
Introduction:
We evaluated the inter- and intra-observer reproducibility of two classification systems for central talar fractures (Hawkins, as modified by Canal and Kelly and then by us; AO/AOT).
Hypothesis:
The analysis and classification of these fractures will be better with CT scans than with X-rays.
Material And Methods:
Four observers evaluated 39 X-ray and CT scan files twice in the span of six weeks; each evaluation entailed classifying the fractures and describing their main features. Cohen's Kappa coefficient for inter-rater agreement was calculated and analysed.
Results:
The inter- and intra-observer reproducibility with CT scans was better with X-rays for most of the parameters evaluated. The modified Hawkins classification provided better reproducibility than the AO/AOT one. However, this classification system was not perfect, even after modifications and use of CT scans.
Discussion:
CT scans are an essential tool for the analysis of all talar fractures. We modified the Hawkins classification (as modified by Canal and Kelly) to include a Type 0 (no displacement or less than 2mm), include frontal body fractures that are displaced like neck fractures and take into account comminuted fractures and other trauma in the area.
Level Of Proof:
IV - retrospective clinical study.
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