Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Cologne, Cologne, Germany.
Foot Ankle Spec. 2024 Dec;17(6):613-620. doi: 10.1177/19386400241250154. Epub 2024 May 10.
The Bartoníček/Rammelt classification is established for posterior malleolar fractures. It subdivides the fractures into 5 types and outlines treatment recommendations. This study aims to determine the intraobserver and interobserver reliability of the Bartoníček/Rammelt classification and investigates its applicability regarding treatment recommendations.
Computed tomography (CT) scans of 80 ankle fractures with a posterior malleolar fracture were analyzed by four observers at two different time points 30 days apart (d1 and d2). Intrarater and interrater reliability was measured using kappa values. The corresponding surgery rates of the fracture subtypes were analyzed, and the surgery rates were correlated with fragment sizes and displacements.
A moderate interobserver reliability for d1 0.41 (CI 0.35-0.47) and d2 0.42 (CI 0.36-0.48) was detected. Intraobserver reliability was documented as perfect, with a mean kappa of 0.83. Type II fractures were operated on in 50% of cases. In 50% of type II cases, a nonoperative treatment was chosen. Fragment size correlated strongly with the chosen therapy, and osteosynthesis was performed significantly more often when the fragment size exceeded 3 cm (P < .01).
The Bartoníček/Rammelt classification system showed moderate interobserver reliability and perfect to substantial intraobserver reliability. In clinical practice of this study cohort, the size of the posterior malleolar fragment rather than the dislocation and joint impaction seemed to have the decision to operate on type II or III fractures. Existing treatment recommendations based on the Bartoníček/Rammelt classification correspond to the therapy algorithm carried out in this cohort of patients. Level III: Retrospective study.
巴顿尼切克/拉梅尔特分类法是为后踝骨折而建立的。它将骨折分为 5 型，并提出了治疗建议。本研究旨在确定巴顿尼切克/拉梅尔特分类法的观察者内和观察者间可靠性，并研究其在治疗建议方面的适用性。
对 80 例伴有后踝骨折的踝关节骨折的计算机断层扫描（CT）进行了分析，由 4 名观察者在 30 天（d1 和 d2）的两个不同时间点进行分析。使用kappa 值测量内部和观察者间的可靠性。分析了骨折亚型的相应手术率，并将手术率与碎片大小和移位相关联。
在 d1 时检测到中度观察者间可靠性为 0.41（CI 0.35-0.47），在 d2 时为 0.42（CI 0.36-0.48）。记录到完美的观察者内可靠性，平均kappa 值为 0.83。50%的 II 型骨折需要手术治疗。在 50%的 II 型病例中，选择了非手术治疗。碎片大小与所选治疗方法密切相关，当碎片大小超过 3cm 时，进行骨合成的情况明显更多（P<0.01）。
巴顿尼切克/拉梅尔特分类系统显示出中度的观察者间可靠性和完美到实质性的观察者内可靠性。在本研究队列的临床实践中，后踝骨碎片的大小而不是脱位和关节嵌顿似乎决定了对 II 型或 III 型骨折进行手术。基于巴顿尼切克/拉梅尔特分类的现有治疗建议与本队列患者的治疗方案相对应。三级：回顾性研究。
