St George's University Hospital, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, England, UK.
The Princess Alexandra Hospital NHS Trust, Harlow, UK.
Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2601-2608. doi: 10.1007/s00590-023-03476-3. Epub 2023 Feb 1.
A number of classification systems exist for posterior malleolar ankle fractures. The user reliability of these classification systems remains unclear. The primary aim of this study was to evaluate the reliability of three commonly utilised classification systems for fractures of the posterior malleolus.
Imaging of 60 patients across 2 hospitals with ankle fractures including a posterior malleolar fragment was identified. All patients had undergone plain radiographs and computed tomography of their injured ankle as part of their normal standard of care. 9 surgeons including pre-resident/registrar level, resident/registrar level, and attending/consultant level applied the Haraguchi, Bartoníček, and Mason classifications to these fractures, at two timepoints, at least 4 weeks apart. The order was randomised between assessments. Inter-rater reliability was assessed using Fleiss' κ and standard error (SE). Intra-rater reliability was assessed using Cohen's κ and standard error (SE).
Inter-rater reliability (Fleiss' κ) was calculated for the Haraguchi classification as 0.588 (SE 0.023), for the Bartoníček classification as 0.626 (SE 0.019), and the Mason classification as 0.541 (SE 0.098). Intra-rater reliability (Cohen's κ) was 0.761 (SE 0.098) for the Haraguchi classification, 0.761 (SE 0.091) for the Bartoníček, classification, and 0.724 (SE 0.096) for the Mason classification.
This study reports the inter-rater and intra-rater reliability for three classification systems for posterior malleolus fractures. Based on definitions by Landis and Koch (Biometrics 33:159-174, 1977), inter-rater reliability was rated as 'moderate' for the Haraguchi and Mason classifications and 'substantial' for the Bartoníček classification. Similarly, the intra-rater reliability was rated as 'substantial' for all three classifications.
存在多种用于后踝骨折的分类系统。这些分类系统的使用者可靠性尚不清楚。本研究的主要目的是评估三种常用于后踝骨折的分类系统的可靠性。
在两家医院中识别出 60 例踝关节骨折（包括后踝骨块）的患者。所有患者均接受了常规标准护理下的踝关节平片和计算机断层扫描。9 名外科医生（包括住院医师/住院医师以下级别、住院医师/住院医师以上级别和主治医生/顾问级别）在至少 4 周的间隔时间内，两次使用 Haraguchi、Bartoníček 和 Mason 分类法对这些骨折进行分类，两次评估的顺序是随机的。采用 Fleiss'κ和标准误差（SE）评估组内可靠性。采用 Cohen'κ和标准误差（SE）评估组内可靠性。
Haraguchi 分类法的组内可靠性（Fleiss'κ）为 0.588（SE 0.023），Bartoníček 分类法为 0.626（SE 0.019），Mason 分类法为 0.541（SE 0.098）。Haraguchi 分类法的组内可靠性（Cohen'κ）为 0.761（SE 0.098），Bartoníček 分类法为 0.761（SE 0.091），Mason 分类法为 0.724（SE 0.096）。
本研究报告了三种后踝骨折分类系统的组内和组间可靠性。根据 Landis 和 Koch（Biometrics 33:159-174, 1977）的定义，Haraguchi 和 Mason 分类法的组间可靠性为“中等”，Bartoníček 分类法的组间可靠性为“强”。同样，三种分类法的组内可靠性均为“强”。
