Reproducibility of the stability-based classification for ankle fractures

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.