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Reproducibility of the stability-based classification for ankle fractures.

Bjarke Viberg1,2,3, Tamim A Haidari4, Jesper Stork-Hansen4

  • 1Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark. Bjarke.viberg@rsyd.dk.

European Journal of Orthopaedic Surgery & Traumatology : Orthopedie Traumatologie
|February 22, 2019
PubMed
Summary

Ankle fracture stability assessment shows substantial agreement, comparable to Lauge-Hansen and AO classifications. This finding aids in treatment decisions for ankle fractures.

Keywords:
Ankle fractureClassificationReproducibilityStability

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Area of Science:

  • Orthopedic Traumatology
  • Radiology
  • Medical Statistics

Background:

  • Accurate ankle fracture classification is crucial for guiding operative versus conservative treatment strategies.
  • Existing classification systems, such as Lauge-Hansen and Arbeitsgemeinschaft für Osteosynthesefragen (AO), are widely used but their reproducibility requires ongoing assessment.
  • Evaluating the reliability of ankle stability assessment is essential for consistent clinical decision-making in managing primary ankle fractures.

Purpose of the Study:

  • To assess the interrater and intrarater reliability of a specific ankle stability assessment method.
  • To compare the reproducibility of this stability assessment with established Lauge-Hansen and AO classifications for ankle fractures.
  • To determine the clinical utility of ankle stability assessment in adult patients with primary ankle fractures.

Main Methods:

  • A retrospective review of X-ray images from 496 consecutive adult ankle fractures.
  • Image interpretation was performed by a diverse group of raters: 2 medical students, 2 residents, and 1 orthopedic traumatology consultant.
  • Unweighted Kappa statistics were employed to quantify interrater and intrarater agreement, with raters blinded to each other's assessments and their own prior results.

Main Results:

  • Interrater reliability (Kappa) for Lauge-Hansen classification was 0.65, for AO classification was 0.62, and for the stability assessment was 0.61.
  • Intrarater reliability varied by rater experience, with mean Kappa values ranging from 0.64-0.80 for medical students, 0.65-0.81 for residents, and 0.82-0.84 for the consultant.
  • The stability assessment demonstrated substantial to almost-perfect agreement among raters.

Conclusions:

  • The evaluated ankle stability assessment exhibits a level of agreement comparable to the widely recognized Lauge-Hansen and AO classification systems.
  • The findings suggest that ankle stability assessment is a reproducible tool for evaluating primary ankle fractures.
  • This reproducible assessment can support clinical decision-making regarding treatment options for ankle fractures.