Department of Orthopedics and Traumatology, Acıbadem Health Group, Ataşehir Acıbadem Hospital, Istanbul, Türkiye.
Department of Orthopedics and Traumatology, Istanbul University School of Medicine, Istanbul, Türkiye.
Acta Orthop Traumatol Turc. 2024 Jun 13;58(3):176-181. doi: 10.5152/j.aott.2024.23155.
Three computed tomography (CT)-based classifications, including Haraguchi, Bartoníček-Rammelt, and Mason-Molloy systems, have been developed to better determine the characteristics of posterior malleolus fractures (PMFs). The aims of this study were (1) to determine the intra- and inter-observer reliability of the computed tomography-based classification systems and (2) to investigate the clinical experience and expertise on their reliabilities. Sixty-seven preoperative ankle CT scans of 67 adult patients with "ankle fracture with the involvement of the posterior malleolus"'' were retrospectively identified. CT images were assessed by 10 observers with different levels of clinical experience from 2 different specialties, including orthopedics and radiology. The observers were asked to classify PMFs according to 3 CT-based classifications on 2 separate occasions with a 4-week interval. Cohen's κ values were measured for 2 raters and Fleiss' κ values were measured for 3 raters and more. Overall, each classification had moderate to very good intraobserver reliability (κ=0.41 to 0.95, P < .01) as well as moderate interobserver reliability for each of the 2 separate assessments (κ=0.41 to 0.60, P < .01 for the first occasion; κ=0.44 to 0.59, P < .01 for the second occasion). Interobserver agreement among the foot and ankle surgeons regarding the Haraguchi and Bartoníček classifications was substantial for both assessment periods, whereas there was a moderate agreement for the Mason classification. Orthopedic residents showed moderate interobserver agreement in each period for both Bartoníček and Mason classifications. Radiology experts illustrated slight and fair agreements in the 2 assessments for Mason classification, moderate agreement in both assessments for Haraguchi classification, and substantial to moderate agreement in the first and second assessments for Bartoníček classification, respectively. Computed tomography-based classification system for PMFs demonstrated moderate interobserver reliability as well as moderate to very good intraobserver reliability. Moreover, foot and ankle specialists exhibit enhanced K values for both inter and intraobserver reliability for each classification system, consistency seems to increase as the interest in the field condenses.
三种基于计算机断层扫描（CT）的分类方法，包括 Haraguchi、Bartoníček-Rammelt 和 Mason-Molloy 系统，已经被开发出来以更好地确定后踝骨折（PMF）的特征。本研究的目的是：（1）确定基于 CT 的分类系统的内部和观察者间可靠性；（2）研究他们的可靠性的临床经验和专业知识。回顾性地确定了 67 例成年患者的 67 例术前踝关节 CT 扫描，这些患者均为“踝关节骨折伴后踝受累”。由来自两个不同专业（骨科和放射科）的 10 名具有不同临床经验的观察者评估 CT 图像。观察者被要求根据 3 种基于 CT 的分类方法，在 2 次不同的评估中进行分类，间隔 4 周。对于 2 名观察者，测量 Cohen's κ 值，对于 3 名及以上观察者，测量 Fleiss' κ 值。总体而言，每种分类在 2 次评估中均具有中度至非常好的观察者内可靠性（κ=0.41 至 0.95，P<.01），并且在 2 次单独评估中的观察者间可靠性也为中度（κ=0.41 至 0.60，P<.01 为第一次评估；κ=0.44 至 0.59，P<.01 为第二次评估）。对于 Haraguchi 和 Bartoníček 分类，足踝外科医生之间的观察者间一致性在两个评估期均为中等，而对于 Mason 分类则为中度。骨科住院医师在每个评估期对 Bartoníček 和 Mason 分类均表现出中度的观察者间一致性。放射科专家在 Mason 分类的两个评估中显示出轻微和公平的一致性，在 Haraguchi 分类的两个评估中显示出中度一致性，在 Bartoníček 分类的第一个和第二个评估中分别显示出实质性到中度一致性。PMF 的基于 CT 的分类系统显示出中度的观察者间可靠性以及中度至非常好的观察者内可靠性。此外，足踝外科专家在每个分类系统的观察者内和观察者间可靠性方面表现出更高的 K 值，随着对该领域的兴趣集中，一致性似乎会增加。
