Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2024 Oct;16(5):688-693. doi: 10.4055/cios23292. Epub 2024 Jun 7.
The Arbeitsgemeinschaft für Osteosynthesefragen (AO) and the Orthopaedic Trauma Association (OTA) classification system for diaphyseal fracture has been recently revised to refine and enhance the accuracy of fracture categorization. This study aimed to investigate the interobserver reliability of the new AO/OTA classification and to compare it with the older version in femoral shaft fractures.
We retrospectively analyzed 139 patients (mean age, 43.8 ± 19.5 years; 92 men and 47 women) with femoral shaft fractures who were treated from 2003 to 2017. Four well-trained observers independently classified each fracture following the previous and revised AO/OTA classification system. We calculated the Fleiss kappa for the interobserver reliability.
The previous classification showed the kappa value of 0.580 (95% confidence interval [CI], 0.547-0.613), and the revised version showed 0.528 (95% CI, 0.504-0.552). Both the old and the revised versions showed moderate reliability.
Our study highlights the moderate interobserver reliability of both the previous and new AO/OTA classification systems for diaphyseal femur fractures. These findings emphasize the importance of standardized systems in clinical decision-making and underscore the need for ongoing education and collaboration to enhance fracture classification.
Arbeitsgemeinschaft für Osteosynthesefragen（AO）和 Orthopaedic Trauma Association（OTA）的骨干骨折分类系统最近进行了修订，以提高骨折分类的准确性。本研究旨在探讨新的 AO/OTA 分类的观察者间可靠性，并将其与股骨干骨折的旧版进行比较。
我们回顾性分析了 2003 年至 2017 年期间治疗的 139 例股骨干骨折患者（平均年龄 43.8±19.5 岁；92 名男性和 47 名女性）。4 名训练有素的观察者分别按照旧版和新版 AO/OTA 分类系统对每个骨折进行分类。我们计算了观察者间可靠性的 Fleiss kappa 值。
旧版分类的 kappa 值为 0.580（95%置信区间[CI]，0.547-0.613），修订版为 0.528（95%CI，0.504-0.552）。旧版和新版均显示出中度可靠性。
我们的研究强调了旧版和新版 AO/OTA 骨干骨折分类系统的观察者间可靠性为中度。这些发现强调了标准化系统在临床决策中的重要性，并突出了需要不断进行教育和协作以提高骨折分类的必要性。
