Aktan Cemil, Kose Ozkan
Department of Orthopedics and Traumatology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey.
J Orthop Surg Res. 2025 Feb 3;20(1):130. doi: 10.1186/s13018-025-05539-z.
The purpose of this study was to introduce and evaluate the Descriptive Ankle Fracture Classification (DAFC) system, a novel alphanumeric method for categorizing ankle fractures and fracture dislocations, and to assess its reliability and prognostic value compared to traditional classification systems (AO/OTA, Weber, and Lauge-Hansen).
A retrospective review was conducted on 90 patients who underwent surgical treatment for ankle fractures. Four observers of varying experience levels classified the fractures using the DAFC, AO/OTA, Weber, and Lauge-Hansen classification systems. Interobserver and intraobserver reliability were evaluated using Fleiss' Kappa coefficient. Functional outcomes were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) and Olerud Molander Ankle Score (OMAS) systems, and comparisons were made across classification systems to determine prognostic value.
The DAFC system demonstrated superior interobserver reliability, particularly for medial malleolus fractures (Kappa = 0.935-0.954) and syndesmotic injuries (Kappa = 0.873-0.891), compared to the other systems. Intraobserver reliability was consistently high across all categories in the DAFC system, with Kappa values ranging from 0.967 to 1.000. Functional outcomes revealed significant associations with the DAFC classification: patients with complete dislocation (D2) had significantly lower AOFAS and OMAS scores than those without dislocation (D0) (P = 0.011), and those with larger posterior malleolus fractures (P2) had poorer OMAS scores (P = 0.014). No statistically significant differences in AOFAS or OMAS scores were observed across AO/OTA, Weber, or Lauge-Hansen classifications.
The DAFC system offers a reliable and comprehensive framework for ankle fracture classification, with the added benefit of prognostic insights, particularly regarding dislocation and posterior malleolus involvement. Its high interobserver and intraobserver reliability, even among observers with varying experience, suggests that the DAFC system is valuable for clinical use. Future research should focus on validating these findings in larger cohorts and assessing the DAFC system's impact on long-term patient outcomes.
Level IV, Retrospective cohort.
本研究旨在介绍和评估描述性踝关节骨折分类（DAFC）系统，这是一种用于对踝关节骨折和骨折脱位进行分类的新型字母数字方法，并评估其与传统分类系统（AO/OTA、Weber和Lauge-Hansen）相比的可靠性和预后价值。
对90例接受踝关节骨折手术治疗的患者进行回顾性研究。四名经验水平不同的观察者使用DAFC、AO/OTA、Weber和Lauge-Hansen分类系统对骨折进行分类。使用Fleiss' Kappa系数评估观察者间和观察者内的可靠性。使用美国矫形足踝协会（AOFAS）和Olerud Molander踝关节评分（OMAS）系统评估功能结果，并在各分类系统之间进行比较以确定预后价值。
与其他系统相比，DAFC系统显示出更高的观察者间可靠性，特别是对于内踝骨折（Kappa = 0.935 - 0.954）和下胫腓联合损伤（Kappa = 0.873 - 0.891）。DAFC系统在所有类别中的观察者内可靠性始终很高，Kappa值范围为0.967至1.000。功能结果显示与DAFC分类有显著关联：完全脱位（D2）的患者的AOFAS和OMAS评分明显低于无脱位（D0）的患者（P = 0.011），后踝骨折较大（P2）的患者的OMAS评分较差（P = 0.014）。在AO/OTA、Weber或Lauge-Hansen分类中，未观察到AOFAS或OMAS评分有统计学显著差异。
DAFC系统为踝关节骨折分类提供了一个可靠且全面的框架，具有预后洞察的额外优势，特别是关于脱位和后踝受累情况。其在观察者间和观察者内的高可靠性，即使在经验不同的观察者中也是如此，表明DAFC系统在临床应用中具有价值。未来的研究应侧重于在更大的队列中验证这些发现，并评估DAFC系统对患者长期预后的影响。
IV级，回顾性队列研究。
