Evaluation of the reliability and repeatability of the classification system of distal radius fractures and the effect of increasing CT on the evaluation results

doi:10.3877/cma.j.issn.2096-0263.2024.05.002

Abstract

Abstract:

Objective

Consistency testing is performed on the main classification system of distal radius fractures, which provides an important guidance for clinicians to choose the classification system.

Methods

A retrospective study was performed. From January 1, 2014 to June 31, 2018, 220 patients with distal radius fractures were included in our hospital. Three observers randomly selected and evaluated the radiography data of 50 cases by AO/OTA, Frykman, Fernández and Universal at four different time nodes of T1, T2, T3 and T4. Time nodes T1 and T2 were used to determine the intra-observer repeatability of each observer based on DR. Time nodes T3 and T4 were used to determine the intra-observer repeatability of each observer based on DR and CT+2D. Cohen' s kappa was used to calculate consistency.

Results

Inter-observer reliability Kappa values based on DR and DR+CT: AO/OTA classification 0.14 vs. 0.32; AO/OTA grouping 0.18 vs. 0.35; Frykman 0.34 vs. 0.29; Fernández 0.31 vs. 0.22; Universal 0.27 vs. 0.30. The intra-observer repeatability Kappa value: AO/OTA typing 0.47 vs. 0.67; AO/OTA grouping 0.48 vs. 0.67; Frykman 0.70 vs. 0.66; Fernández 0.59 vs. 0.58; Universal 0.60 vs. 0.59.

Conclusion

The increase of CT+2D examination may not improve the observer consistency results of Frykman classification, Fernández classification, and Universal classification. The observer consistency results of AO/OTA classification and AO/OTA grouping can be improved. Based on previous study and our research, there is currently no gold standard for the classification of distal radius fractures or the recommended classification.

Key words: Distal radius fractures, Fracture, Classification

Jun Zhang, Jianmin Zhao, Xiaoke Yao, Haoyu Ji, Ruixiang Yue. Evaluation of the reliability and repeatability of the classification system of distal radius fractures and the effect of increasing CT on the evaluation results[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(05): 264-272.

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References 26

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研究	年份	AO（分型）	AO（分组）	Frykman	Fernández	Universal
Andersen^[10]	1996	0.64	0.29	0.36
Kreder^[9]	1996	0.68	0.48
Osakam^[11]	2001	0.65
Oliveira Filho^[12]	2004			0.35		0.33
Jin^[13]	2007	0.46	0.27	0.36		0.36
Yunes Filho^[25]	2009	0.47	0.32			0.42
Naqvi^[14]	2009				0.27
Kural^[15]	2010		0.10	0.22	0.24	0.23
Van Leerdam^[16]	2010	0.60	0.41
Sirpakarn^[6]	2013		0.34	0.28	0.41
Kucuk^[17]	2013		0.34	0.40	0.46	0.32
Arealis^[20]	2014		0.30		0.43	0.27
			0.30（CT）		0.40（CT）	0.19（CT）
Plant^[7]	2015	0.56	0.29
van Buijtenen^[23]	2015	0.49	0.48
Kleinlugtenbelt^[21]	2017		0.26	0.40	028	0.20
			0.28（CT）	0.36（CT）	0.26（CT）	0.11（CT）
本文研究	2023	0.140	0.184	0.343	0.309	0.273
		0.318（CT）	0.35 CT）	0.285 CT）	0.222 CT）	0.303 CT）

研究	年份	AO（分型）	AO（分组）	Frykman	Fernández	Universal
Andersen^[10]	1996	0.64	0.29	0.36
Kreder^[9]	1996	0.68	0.48
Osakam^[11]	2001	0.65
Oliveira Filho^[12]	2004			0.35		0.33
Jin^[13]	2007	0.46	0.27	0.36		0.36
Yunes Filho^[25]	2009	0.47	0.32			0.42
Naqvi^[14]	2009				0.27
Kural^[15]	2010		0.10	0.22	0.24	0.23
Van Leerdam^[16]	2010	0.60	0.41
Sirpakarn^[6]	2013		0.34	0.28	0.41
Kucuk^[17]	2013		0.34	0.40	0.46	0.32
Arealis^[20]	2014		0.30		0.43	0.27
			0.30（CT）		0.40（CT）	0.19（CT）
Plant^[7]	2015	0.56	0.29
van Buijtenen^[23]	2015	0.49	0.48
Kleinlugtenbelt^[21]	2017		0.26	0.40	028	0.20
			0.28（CT）	0.36（CT）	0.26（CT）	0.11（CT）
本文研究	2023	0.140	0.184	0.343	0.309	0.273
		0.318（CT）	0.35 CT）	0.285 CT）	0.222 CT）	0.303 CT）

研究	年份	AO（分型）	AO（分组）	Frykman	Fernández	Universal
Andersen^[10]	1996	0.58～0.70	0.35～0.38	0.40～0.61
Kreder^[9]	1996	0.67～0.86
Lllarremendi^[18]	1998
Oliveira Filho^[12]	2004			0.55		0.54
Jin^[13]	2007	0.49	0.36	0.54
Belloti^[24]	2008			0.55	0.59	0.61
Ploegmakers^[19]	2009		0.52	0.26	0.42
Naqvi^[14]	2009				0.29～0.48
Kural^[15]	2010		0.31	0.31	0.47	0.62
Kucuk^[17]	2013		0.50	0.60	0.60	0.49
Sirpakarn^[6]	2013		0.29	0.31	0.34
Plant^[7]	2015	0.68	0.70
van Buijtenen^[23]	2015	0.65	0.53
Kleinlugtenbelt^[21]	2017		0.40	0.49	0.45	0.40
			0.41（CT）	0.50（CT）	0.54（CT）	0.32（CT）
本文研究	2023	0.470	0.483	0.702	0.592	0.597
		0.665（CT）	0.671（CT）	0.664（CT）	0.584（CT）	0.590（CT）

研究	年份	AO（分型）	AO（分组）	Frykman	Fernández	Universal
Andersen^[10]	1996	0.58～0.70	0.35～0.38	0.40～0.61
Kreder^[9]	1996	0.67～0.86
Lllarremendi^[18]	1998
Oliveira Filho^[12]	2004			0.55		0.54
Jin^[13]	2007	0.49	0.36	0.54
Belloti^[24]	2008			0.55	0.59	0.61
Ploegmakers^[19]	2009		0.52	0.26	0.42
Naqvi^[14]	2009				0.29～0.48
Kural^[15]	2010		0.31	0.31	0.47	0.62
Kucuk^[17]	2013		0.50	0.60	0.60	0.49
Sirpakarn^[6]	2013		0.29	0.31	0.34
Plant^[7]	2015	0.68	0.70
van Buijtenen^[23]	2015	0.65	0.53
Kleinlugtenbelt^[21]	2017		0.40	0.49	0.45	0.40
			0.41（CT）	0.50（CT）	0.54（CT）	0.32（CT）
本文研究	2023	0.470	0.483	0.702	0.592	0.597
		0.665（CT）	0.671（CT）	0.664（CT）	0.584（CT）	0.590（CT）

Kappa	可重复性
<0	完全不可信（Poor）
0.01-0.2	轻度可信（Slight）
0.21-0.4	轻中可信（Fair）
0.41-0.6	中度可信（Moderate）
0.61-0.8	基本可信（Substantial）
0.81-1	完全可信（Excellent）

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