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Interobserver Reliability of 2 Classification Systems for Open Hand Fractures.

William J Warrender1, Christopher J Lucasti1, Asif Ilyas1

  • 1Thomas Jefferson University, Philadelphia, PA, USA.

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|April 6, 2019
PubMed
Summary

The Tulipan-Ilyas (TI) classification shows better reliability than the Gustilo-Anderson (GA) system for open hand fractures. This hand-specific TI system offers improved interobserver agreement for guiding treatment.

Keywords:
Gustilo-Andersonanatomyclassificationhandopen hand fracturesspecialtysurgery

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Trauma Classification

Background:

  • Open fractures of the hand require accurate classification for effective treatment.
  • Existing classification systems, like Gustilo-Anderson (GA), may lack specificity for hand injuries.
  • The Tulipan-Ilyas (TI) classification is a novel system proposed for open hand fractures.

Purpose of the Study:

  • To assess the interobserver reliability of the Tulipan-Ilyas (TI) classification system.
  • To compare the interobserver reliability of the TI system against the established Gustilo-Anderson (GA) system.
  • To evaluate the utility of the TI system in guiding treatment decisions for open hand fractures.

Main Methods:

  • Surgeons were blinded to the TI classification system's origin and development.
  • Interobserver reliability was calculated using Fleiss' multi-rater kappa (κ).
  • Interrater reliability was assessed using Shrout and Fleiss methods and intraclass correlation coefficients (ICCs).

Main Results:

  • The TI classification demonstrated moderate agreement (κ=0.443) compared to the GA classification's fair agreement (κ=0.339).
  • Interrater agreement for single measures was excellent for TI (ICC=0.958) and good for GA (ICC=0.595).
  • Both systems showed excellent interrater agreement for average measures (ICC > 0.91).

Conclusions:

  • The Tulipan-Ilyas (TI) classification system exhibits superior interobserver reliability for open hand fractures.
  • The TI system's hand-specific nature and improved reliability support its recommendation over the GA system.
  • The TI classification is proposed as a more effective tool for classifying and managing open hand fractures.