Weber Ankle Fracture Classification System Yields Greatest Interobserver and Intraobserver Reliability Over AO/OTA...

Area of Science:

• Orthopaedic surgery
• Radiology
• Trauma classification

Background:

• Ankle malleolar fractures require accurate classification for effective treatment.
• Existing classification systems (Weber, Lauge-Hansen, AO/OTA) have varying reported reliability.
• No studies have assessed their reliability under time constraints.

Purpose of the Study:

• To compare the inter- and intraobserver reliability of Weber, Lauge-Hansen, and AO/OTA classification systems for ankle malleolar fractures.
• To evaluate the impact of simulated time constraints on this reliability.

Main Methods:

• Anteroposterior and lateral radiographs of 80 ankle fractures were reviewed.
• Two independent observers classified fractures using Weber, Lauge-Hansen, and AO/OTA systems.
• Classifications were performed under timed (25 seconds) and untimed conditions over four weeks, with Cohen's kappa and percentage agreement calculated.

Main Results:

• Weber system showed substantial inter- and intraobserver agreement (kappa 0.67-0.85).
• Lauge-Hansen system demonstrated moderate agreement (kappa 0.38-0.73).
• AO/OTA system exhibited fair to moderate agreement (kappa 0.13-0.63).
• Time constraints did not significantly affect the reliability of any system.

Conclusions:

• The Weber classification system offers the highest reliability and reproducibility for ankle malleolar fractures.
• The Lauge-Hansen system also shows good reliability.
• Concurrent use of Weber and Lauge-Hansen systems is recommended for comprehensive fracture assessment.