Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, P. R. China; Orthopaedic Institution of Hebei Province, Shijiazhuang 050051, Hebei, P. R. China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, P. R. China; NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang 050051, Hebei, P. R. China.
School of Medicine, Nankai University, Tianjin 300071, P.R. China.
J Foot Ankle Surg. 2023 Jul-Aug;62(4):644-650. doi: 10.1053/j.jfas.2023.01.010. Epub 2023 Feb 2.
This study aimed to develop a comprehensive classification system for fractures of the lateral process of the talus (LPTF) based on CT, and to evaluate its prognostic value, reliability and reproducibility. We retrospectively reviewed 42 patients involving LPTF with an average follow-up of 35.9 months for clinical and radiographic evaluations. In order to develop a comprehensive classification, a panel of experienced orthopedic surgeons discussed the cases. All fractures were classified according to Hawkins, McCrory-Bladin and new proposed classifications by 6 observers. The analysis of interobserver and intraobserver agreements was measured using kappa statistics. The new classification included 2 types based on presence of concomitant injuries or not, with type I consisting of 3 subtypes and type II of 5 subtypes. Average AOFAS score was 91.5 in the type Ia of new classification, 86 in type Ib, 90.5 in type Ic, 89 in type IIa, 76.7 in type IIb, 76.6 in type IIc, 91.3 in type IId, and 83.5 in type IIe. Interobserver and intraobserver reliability of the new classification system were almost perfect (κ = 0.776 and 0.837, respectively), showing a higher interobserver and intraobserver reliability compared to the Hawkins classification (κ 0.572 and 0.649, respectively) as well as McCrory-Bladin classification (κ = 0.582 and 0.685, respectively). The new classification system is a comprehensive one that takes into account concomitant injuries and shows good prognostic value with clinical outcomes. It is more reliable and reproducible and could be a useful tool for decision-making on treatment options for LPTF.
本研究旨在基于 CT 制定外侧距骨突骨折（LPTF）的全面分类系统，并评估其预后价值、可靠性和可重复性。我们回顾性分析了 42 例 LPTF 患者，平均随访 35.9 个月，进行临床和影像学评估。为了制定全面的分类系统，一组经验丰富的骨科医生对病例进行了讨论。所有骨折均根据 Hawkins、McCrory-Bladin 和新提出的分类由 6 名观察者进行分类。通过kappa 统计分析评估观察者间和观察者内的一致性。新分类包括是否伴有合并伤的 2 种类型，I 型包括 3 个亚型，II 型包括 5 个亚型。新分类中 Ia 型的平均 AOFAS 评分为 91.5，Ib 型为 86，Ic 型为 90.5，IIa 型为 89，IIb 型为 76.7，IIc 型为 76.6，Id 型为 91.3，IIe 型为 83.5。新分类系统的观察者间和观察者内可靠性几乎为完美（κ=0.776 和 0.837），与 Hawkins 分类（κ=0.572 和 0.649）和 McCrory-Bladin 分类（κ=0.582 和 0.685）相比，具有更高的观察者间和观察者内可靠性。新分类系统是一种全面的分类系统，考虑到合并伤，并具有良好的预后价值和临床结果。它更可靠、更具可重复性，可能成为治疗 LPTF 选择方案的有用工具。
