Interobserver Agreement of Ankle Fracture Classification Among Emergency Physicians

Area of Science:

• Orthopaedic surgery
• Radiology
• Medical education

Background:

• Accurate ankle fracture classification is crucial for effective treatment.
• The Danis-Weber system is a widely used method for categorizing ankle fractures.
• Interobserver agreement among physicians can impact diagnostic consistency.

Purpose of the Study:

• To assess interobserver agreement in Danis-Weber ankle fracture classification by emergency physicians.
• To determine if an educational intervention improves diagnostic consistency.

Main Methods:

• Thirteen emergency physicians classified 100 ankle radiographs twice, 4 weeks apart.
• An educational PowerPoint on the Danis-Weber system was emailed between assessments.
• Interobserver agreement was measured using Cohen's Kappa; accuracy was also assessed.

Main Results:

• Initial moderate agreement (Kappa = 0.51) improved to substantial agreement (Kappa = 0.61) in the second assessment.
• The improvement in agreement and accuracy was not statistically significant.
• Physician accuracy was 83% initially and 88% in the second assessment, a non-significant increase.

Conclusions:

• Emergency physicians demonstrated moderate to substantial interobserver agreement in Danis-Weber ankle fracture classification.
• The emailed educational intervention did not significantly enhance diagnostic consistency.
• Alternative educational strategies may be needed to improve ankle fracture classification accuracy.