Inter-observer and Intra-observer Reliability of Posterior Malleolus Fracture Classification Systems.

Area of Science:

• Orthopedic Surgery
• Radiology
• Medical Imaging

Background:

• Posterior malleolar fracture morphology is crucial for managing ankle fractures.
• Existing classification systems aim to categorize these fractures based on morphology.
• Reliability of these systems impacts clinical decision-making and patient outcomes.

Purpose of the Study:

• To compare the inter-observer and intra-observer reliability of three posterior malleolar fracture classification systems: Bartoníček, Haraguchi, and Mason and Molloy.
• To determine which classification system offers the most consistent results among orthopedic specialists.

Main Methods:

• Forty computed tomography (CT) scans of ankle fractures with posterior malleolar components were reviewed.
• Four reviewers (two consultant surgeons, one fellow, one registrar) assessed the scans using the Bartoníček, Haraguchi, and Mason and Molloy classifications on two separate occasions.
• Inter-observer reliability was assessed using Fleiss kappa (κ) statistics, and intra-observer reliability using mean Cohen's kappa (κ) coefficients.

Main Results:

• The Haraguchi classification showed the highest inter-observer reliability (κ=0.65) and intra-observer reliability (mean κ=0.73).
• The Mason and Molloy classification also demonstrated substantial inter-observer reliability (κ=0.63) and good intra-observer reliability (mean κ=0.65).
• The Bartoníček classification exhibited the lowest inter-observer reliability (κ=0.43) and moderate intra-observer reliability (mean κ=0.66).

Conclusions:

• The Haraguchi classification system is the most reliable for categorizing posterior malleolar fractures.
• Both Haraguchi and Mason and Molloy classifications offer substantial inter-observer agreement.
• Further research is needed to evaluate the impact of these classifications on treatment decisions and patient outcomes.