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Reliability of distal radius fracture classification systems: a CT based study.

Madhurima Sharma1, Shayeri Roy Choudhury2, Raghuraman Soundararajan2

  • 1Post Graduate Institute of Medical Education and Research, Chandigarh, India. madhurimashrm88@gmail.com.

Emergency Radiology
|November 5, 2024
PubMed
Summary

No current classification system for distal radius fractures is fully reproducible. The Frykman system showed the best intraobserver reproducibility, while AO/OTA and Frykman performed better for interobserver reliability than Fernandez.

Keywords:
AO/OTAMultidetector computed tomographyradius fractureswrist fractures

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Area of Science:

  • Orthopedic surgery
  • Radiology
  • Medical imaging

Background:

  • Distal radius fractures are common injuries.
  • Accurate classification is crucial for treatment and prognosis.
  • Existing classification systems (AO/OTA, Frykman, Fernandez) have varying reliability.

Purpose of the Study:

  • To evaluate the reliability and reproducibility of three common classification systems for distal radius fractures using computed tomography (CT).
  • To compare the performance of AO/OTA, Frykman, and Fernandez classifications in terms of interobserver and intraobserver agreement.

Main Methods:

  • Four radiologists independently classified 115 distal radius fractures on CT scans using AO/OTA, Frykman, and Fernandez systems.
  • Interobserver reliability was assessed using intraclass correlation coefficient (ICC) and kappa statistics.
  • Intraobserver agreement was evaluated using Cohen's kappa after a six-week interval.

Main Results:

  • Interobserver reliability was fair for AO/OTA (ICC 0.447) and Frykman (ICC 0.432), and poor for Fernandez (ICC 0.196).
  • Intraobserver agreement was substantial for Frykman (Observer 1: 0.754), moderate for AO/OTA (Observer 1: 0.449) and Fernandez (0.333, 0.320).
  • Reliability of AO/OTA decreased with subgroup classification; Fernandez showed the lowest overall reliability.

Conclusions:

  • No current classification system demonstrates complete reproducibility for distal radius fractures on CT.
  • The Frykman system exhibited superior intraobserver reproducibility.
  • AO/OTA and Frykman systems offered better interobserver reliability compared to the Fernandez system.