scholarly journals The Buttazzoni Classification of Distal Radial Fractures in Adults: Interobserver and Intraobserver Reliability

Hand ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 283-288 ◽  
Author(s):  
Mats Å. Wadsten ◽  
Arkan S. Sayed-Noor ◽  
Gùran O. Sjù;dén ◽  
Olle Svensson ◽  
Gunnar G. Buttazzoni
Keyword(s):  
Classification System ◽  
Kappa Coefficient ◽  
Intraobserver Reliability ◽  
Classification Systems ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
New Classification ◽  
Distal Radial Fractures ◽  
Orthopedic Surgeons ◽  
Fracture Types

Despite the fact that distal radial fracture is the commonest fracture, there is a little evidence-based knowledge about the value of its classification to guide management and predict prognosis. The available classification systems are either complicated or weakly applicable in clinical practice. Older's classification is the most reliable, but does not cover all radial fracture types. We evaluated the interobserver and intraobserver reliability of a new classification system which is a modification of Older's classification covering all radial fracture types. Two hundred and thirty-two consecutive adult patients with acute distal radial fractures were blindly evaluated according to the new classification by three orthopedic surgeons twice with 1-year interval. The interobserver reliability was measured using the Fleiss kappa coefficient, and the intraobserver reliability was measured using the Cohen's kappa coefficient. The new classification showed fair to substantial interobserver and intraobserver reliability, i.e., results comparable to the reliability of commonly used classification systems. The reliability was better for younger patients and when evaluation was carried out by hand-surgery-interested orthopedic surgeons. The new classification system is simple, covers all radial fracture types, and has an acceptable reliability. Further studies are needed to judge its ability to direct management and predict prognosis.

Comprehensive classification system for multirod constructs across three-column osteotomies: a reliability study

2021 ◽  
Vol 34 (1) ◽  
pp. 103-109
Author(s):  
Mostafa H. El Dafrawy ◽  
Owoicho Adogwa ◽  
Adam M. Wegner ◽  
Nicholas A. Pallotta ◽  
Michael P. Kelly ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Reliability ◽  
Kappa Coefficient ◽  
Intraobserver Reliability ◽  
Osteotomy Site ◽  
New Classification ◽  
Good Reliability ◽  
Kappa Value ◽  
Comprehensive Classification ◽  
High Degree

OBJECTIVEIn this study, the authors’ goal was to determine the intra- and interobserver reliability of a new classification system that allows the description of all possible constructs used across three-column osteotomies (3COs) in terms of rod configuration and density.METHODSThirty-five patients with multirod constructs (MRCs) across a 3CO were classified by two spinal surgery fellows according to the new system, and then were reclassified 2 weeks later. Constructs were classified as follows: the number of rods across the osteotomy site followed by a letter corresponding to the type of rod configuration: “M” is for a main rod configuration, defined as a single rod spanning the osteotomy. “L” is for linked rod configurations, defined as 2 rods directly connected to each other at the osteotomy site. “S” is for satellite rod configurations, which were defined as a short rod independent of the main rod with anchors above and below the 3CO. “A” is for accessory rods, defined as an additional rod across the 3CO attached to main rods but not attached to any anchors across the osteotomy site. “I” is for intercalary rod configurations, defined as a rod connecting 2 separate constructs across the 3CO, without the intercalary rod itself attached to any anchors across the osteotomy site. The intra- and interobserver reliability of this classification system was determined.RESULTSA sample estimation for validation assuming two readers and 35 subjects results in a two-sided 95% confidence interval with a width of 0.19 and a kappa value of 0.8 (SD 0.3). The Fleiss kappa coefficient (κ) was used to calculate the degree of agreement between interrater and intraobserver reliability. The interrater kappa coefficient was 0.3, and the intrarater kappa coefficient was 0.63 (good reliability). This scenario represents a high degree of agreement despite a low kappa coefficient. Correct observations by both observers were 34 of 35 and 33 of 35 at both time points. Misclassification was related to difficulty in determining connectors versus anchors.CONCLUSIONSMRCs across 3COs have variable rod configurations. Currently, no classification system or agreement on nomenclature exists to define the configuration of rods across 3COs. The authors present a new, comprehensive MRC classification system with good inter- and intraobserver reliability and a high degree of agreement that allows for a standardized description of MRCs across 3COs.

scholarly journals Volar Fixation of Dorsally Displaced Distal Radial Fracture Using Locking Compression Plate

2005 ◽  
Vol 13 (2) ◽  
pp. 153-157 ◽  
Author(s):  
KK Wong ◽  
KW Chan ◽  
TK Kwok ◽  
KH Mak
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Locking Compression Plate ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Distal Radial Fractures ◽  
Compression Plate ◽  
One Year ◽  
Compression Plating ◽  
Unstable Fractures

Purpose. To evaluate the functional and radiological results of treating unstable fractures of the dorsal distal radius with a volar locking plate. Methods. Dorsally displaced distal radial fractures in 30 patients (11 men and 19 women; mean age, 58.6 years) were fixed by volar locking compression plate and followed up for a minimum of one year. Results. At final functional assessment, 24 patients achieved excellent and 5 achieved good outcomes, with one patient exhibiting fair results. Radiological scores demonstrated 22 excellent and 8 good outcomes. No nonunion or infection occurred. Conclusion. Volar locking compression plating is a safe and effective treatment for unstable fractures of the dorsal distal radius.

scholarly journals Fractures of the Lateral Process of the Talus: A New Classification Based on CT

2021 ◽  
Author(s):  
Yuchuan Wang ◽  
Yanbin Zhu ◽  
Xiangtian Deng ◽  
Zhongzheng Wang ◽  
Siyu Tian ◽  
...  
Keyword(s):  
Classification System ◽  
Intraobserver Reliability ◽  
Kappa Statistics ◽  
Type I ◽  
New Classification ◽  
Concomitant Injuries ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Lateral Process ◽  
Comprehensive Classification

Abstract Background: The common classifications of the fractures of the lateral process of the talus（LTPFs）are based on radiographs and may underestimate the complexity of LTPF, therefore, requiring a comprehensive classification based on CT(Computed tomography) scan. The aim of this study is to propose a such classification system, and to evaluate its reliability and reproducibility.Methods: On the basis of the most widely recognized classifications of Hawkins as well as McCrory-Bladin, we proposed a new and comprehensive classification based on CT scan for the LTPF. We retrospectively reviewed 42 patients involving LTPF. All fractures were classified according to Hawkins, McCrory-Bladin and new proposed classification system by three surgeons. The analysis of interobserver and intraobserver agreements was done using kappa statistics.Results: This new classification included two types based on presence of concomitant injuries or not, with type I consisting of three subtypes and type II of five subtypes. Interobserver and intraobserver reliability of the new classification system were almost perfect (κ=0.846 and 0.823, respectively)，showing a higher interobserver and intraobserver reliability compared to the Hawkins classification (κ=0.737 and 0.689, respectively) as well as McCrory-Bladin classification (κ=0.748 and 0.714, respectively). Conclusion: This new classification system for the LTPF based on CT is a comprehensive classification considering concomitant injuries. It is more reliable and reproducible and can potentially become a useful instrument for decision making of treatment options for LTPFs. Further studies on the evaluation of their clinical relevance (especially the long-term outcome) are warranted.

scholarly journals Inter- and intraobserver agreement of three classification systems for lateral clavicle fractures – reliability comparison between two specialist groups

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Thomas Rauer ◽  
Matthias Boos ◽  
Valentin Neuhaus ◽  
Prasad Ellanti ◽  
Robert Alexander Kaufmann ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Agreement ◽  
Intraobserver Reliability ◽  
Classification Systems ◽  
Neer Classification ◽  
Lateral Clavicle ◽  
Kappa Value ◽  
Clavicle Fractures ◽  
Specialist Groups ◽  
Trauma Surgeons

Abstract Background Although of great value in the management of lateral clavicle fractures, substantial variation in their classification exists. We performed a retrospective study to address the inter- and intraobserver reliability of three different classification systems for lateral clavicle fractures. Methods Radiographs of 20 lateral clavicle fractures that represented a full spectrum of adult fracture patterns were graded by five experienced radiologists and five experienced trauma surgeons according to the Orthopaedic Trauma Association (OTA), the Neer, and the Jäger/Breitner classification systems. This evaluation was performed at two different time points separated by 3 months. To measure the observer agreement, the Fleiss kappa coefficient (κ) was applied and assessed according to the grading of Landis and Koch. Results The overall interobserver reliability showed a fair agreement in all three classification systems. For the OTA classification system, the interobserver agreement showed a mean kappa value of 0.338 ranging from 0.350 (radiologists) to 0.374 (trauma surgeons). Kappa values of the interobserver agreement for the Neer classification system ranged from 0.238 (trauma surgeons) to 0.276 (radiologists) with a mean κ of 0.278. The Jäger/Breitner classification system demonstrated a mean kappa value of 0.330 ranging from 0.306 (trauma surgeons) to 0.382 (radiologists). The overall intraobserver reliability was moderate for the OTA and the Jäger/Breitner classification systems, while the overall intraobserver reliability for the Neer classification system was fair. The kappa values of the intraobserver agreements showed, in all classification systems, a wide range with the OTA classification system ranging from 0.086 to 0.634, the Neer classification system ranging from 0.137 to 0.448, and a range from 0.154 to 0.625 of the Jäger/Breitner classification system. Conclusions The low inter- and intraobserver agreement levels exhibited in all three classification systems by both specialist groups suggest that the tested lateral clavicle fracture classification systems are unreliable and, therefore, of limited value. We should recognize there is considerable inconsistency in how physicians classify lateral clavicle fractures and therefore any conclusions based on these classifications should be recognized as being somewhat subjective.

The incidence of ulnocarpal complaints after distal radial fracture in relation to the fracture of the ulnar styloid

2012 ◽  
Vol 38 (7) ◽  
pp. 710-717 ◽  
Author(s):  
S. Krämer ◽  
H. Meyer ◽  
P. F. O’Loughlin ◽  
B. Vaske ◽  
C. Krettek ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Grip Strength ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Ulnar Styloid ◽  
Distal Radial Fractures ◽  
Pain Scores ◽  
Ulnar Styloid Fracture ◽  
Loss Of Motion

Two hundred distal radial fractures, with a mean follow up of 20 months (range 6–49), were divided into three groups according to the presence and healing status of an ulnar styloid fracture. The patients underwent both clinical and radiological examination and completed two different questionnaires. One hundred and one, of 200 distal radial fractures, were associated with an ulnar styloid fracture. Forty-six of these developed an ulnar styloid nonunion. The authors encountered significantly higher pain scores (ulnar sided pain p = 0.012), a higher rate of DRUJ instability ( p = 0.032), a greater loss of motion and grip strength ( p = 0.001), and a poorer clinical outcome in cases with an ulnar styloid fracture, but no differences were apparent when those with healed ulnar styloid fractures or ulnar styloid nonunions were compared ( p > 0.05). The investigators propose that the incidence of ulnocarpal complaints following distal radial fracture depends on the presence but not the healing status of an ulnar styloid fracture.

Prospective investigation of the relationship between dorsal tilt, carpal malalignment, and capitate shift in distal radial fractures

2020 ◽  
Vol 102-B (1) ◽  
pp. 137-143
Author(s):  
Rachel Dias ◽  
Nick A. Johnson ◽  
Joseph J. Dias
Keyword(s):  
Operating Characteristic ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Roc Curve Analysis ◽  
Distal Radial Fractures ◽  
Initial Radiograph ◽  
Interval Linear ◽  
Adverse Influence ◽  
The Relationship ◽  
Prospective Investigation

Aims Carpal malalignment after a distal radial fracture occurs due to loss of volar tilt. Several studies have shown that this has an adverse influence on function. We aimed to investigate the magnitude of dorsal tilt that leads to carpal malalignment, whether reduction of dorsal tilt will correct carpal malalignment, and which measure of carpal malalignment is the most useful. Methods Radiographs of patients with a distal radial fracture were prospectively collected and reviewed. Measurements of carpal malalignment were recorded on the initial radiograph, the radiograph following reduction of the fracture, and after a further interval. Linear regression modelling was used to assess the relationship between dorsal tilt and carpal malalignment. Receiver operating characteristic (ROC) analysis was used to identify which values of dorsal tilt led to carpal malalignment. Results A total of 250 consecutive patients with 252 distal radial fractures were identified. All measures of carpal alignment were significantly associated with dorsal tilt at each timepoint. This relationship persisted after adjustment for age, sex, and the position of the wrist. Capitate shift consistently had the strongest relationship with dorsal tilt and was the only parameter that was not influenced by age or the position of the wrist. ROC curve analysis identified that abnormal capitate shift was seen with > 9° of dorsal tilt. Conclusion Carpal malalignment is related to dorsal tilt following a distal radial fracture. Reducing the fracture and improving dorsal tilt will reduce carpal malalignment. Capitate shift is easy to assess visually, unrelated to age and sex, and appears to be the most useful measure of carpal malalignment. The aim during reduction of a distal radial fracture should be to realign the capitate with the axis of the radius and prevent carpal malalignment. Cite this article: Bone Joint J 2020;102-B(1):137–143

scholarly journals Classification systems for gingival recession and suggestion of a new classification system

2018 ◽  
Vol 29 (2) ◽  
pp. 233 ◽  
Author(s):  
Nagappa Guttiganur ◽  
Shivanand Aspalli ◽  
MuktaV Sanikop ◽  
Anupama Desai ◽  
Reetika Gaddale ◽  
...  
Keyword(s):  
Classification System ◽  
Gingival Recession ◽  
Classification Systems ◽  
New Classification

scholarly journals Posttraumatic Lateral Dislocation of Mandibular Condyle: A Proposed New Classification with Report of 14 Dislocated Condyles

2019 ◽  
Vol 12 (4) ◽  
pp. 249-253 ◽  
Author(s):  
Tabishur Rahman ◽  
Ghulam Sarwar Hashmi ◽  
Syed Saeed Ahmed ◽  
Sajjad Abdur Rahman
Keyword(s):  
Clinical Experience ◽  
Classification System ◽  
Clinical Condition ◽  
Mandibular Condyle ◽  
Classification Systems ◽  
Radiological Findings ◽  
New Classification ◽  
Lateral Dislocation

Lateral dislocation of the intact mandibular condyle is a relatively uncommon clinical condition. Since the first description and classification of these dislocations given by Allen and Young, few classification systems have been proposed in literature with incorporation of different patterns of dislocations identified over the years. We share our clinical experience of nine cases of such dislocations with 14 dislocated condyles, and on the basis of clinical and radiological findings coupled with the review of existing classification systems, we propose a new classification system which includes all the possible patterns of such dislocations overcoming the major shortcomings of preexisting classification systems identified by the authors.

Classification and Nomenclature: Progressive Collapsing Foot Deformity

2020 ◽  
Vol 41 (10) ◽  
pp. 1271-1276 ◽  
Author(s):  
Mark S. Myerson ◽  
David B. Thordarson ◽  
Jeffrey E. Johnson ◽  
Beat Hintermann ◽  
Bruce J. Sangeorzan ◽  
...  
Keyword(s):  
Classification System ◽  
Consensus Statement ◽  
Classification Systems ◽  
Posterior Tibial Tendon ◽  
Foot Deformity ◽  
New Classification ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Posterior Tibial ◽  
Consensus Statements

Recommendation: The historical nomenclature for the adult acquired flatfoot deformity (AAFD) is confusing, at times called posterior tibial tendon dysfunction (PTTD), the adult flexible flatfoot deformity, posterior tibial tendon rupture, peritalar instability and peritalar subluxation (PTS), and progressive talipes equinovalgus. Many but not all of these deformities are associated with a rupture of the posterior tibial tendon (PTT), and some of these are associated with deformities either primarily or secondarily in the midfoot or ankle. There is similar inconsistency with the use of classification schemata for these deformities, and from the first introduced by Johnson and Strom (1989), and then modified by Myerson (1997), there have been many attempts to provide a more comprehensive classification system. However, although these newer more complete classification systems have addressed some of the anatomic variations of deformities encountered, none of the above have ever been validated. The proposed system better incorporates the most recent data and understanding of the condition and better allows for standardization of reporting. In light of this information, the consensus group proposes the adoption of the nomenclature “Progressive Collapsing Foot Deformity” (PCFD) and a new classification system aiming at summarizing recent data published on the subject and to standardize data reporting regarding this complex 3-dimensional deformity. Level of Evidence: Level V, consensus, expert opinion. Consensus Statements Voted: CONSENSUS STATEMENT ONE: We will rename the condition to Progressive Collapsing Foot Deformity (PCFD), a complex 3-dimensional deformity with varying degrees of hindfoot valgus, forefoot abduction, and midfoot varus. Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%. (Unanimous, strongest consensus) CONSENSUS STATEMENT TWO: Our current classification systems are incomplete or outdated. Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%. (Unanimous, strongest consensus) CONSENSUS STATEMENT THREE: MRI findings should be part of a new classification system. Delegate vote: agree, 33% (3/9); disagree, 67% (6/9); abstain, 0%. (Weak negative consensus) CONSENSUS STATEMENT FOUR: Weightbearing CT (WBCT) findings should be part of a new classification system. Delegate vote: agree, 56% (5/9); disagree, 44% (4/9); abstain, 0%. (Weak consensus) CONSENSUS STATEMENT FIVE: A new classification system is proposed and should be used to stage the deformity clinically and to define treatment. Delegate vote: agree, 89% (8/9); abstain, 11% (1/9). (Strong consensus)

A comparison of the accuracy of two sets of diagnostic criteria in the early detection of complex regional pain syndrome following surgical treatment of distal radial fractures

2012 ◽  
Vol 38 (6) ◽  
pp. 609-615 ◽  
Author(s):  
A. Żyluk ◽  
H. Mosiejczuk
Keyword(s):  
Surgical Treatment ◽  
Complex Regional Pain Syndrome ◽  
Severity Score ◽  
International Association ◽  
Pain Syndrome ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Distal Radial Fractures ◽  
Need For Treatment ◽  
Severity Scores

A total of 120 patients were examined for the presence of symptoms of complex regional pain syndrome after surgical treatment of a distal radial fracture. The patients were assessed at six weeks and 71 of them were also assessed at 12 weeks. The International Association for the Study of Pain criteria and the complex regional pain syndrome severity score were used to make the diagnosis. At six weeks, ten patients (8.3%) met the criteria of complex regional pain syndrome in both the International Association for the Study of Pain and complex regional pain syndrome scores. At 12 weeks six patients (8.4%) met International Association for the Study of Pain and two (2.8%) patients the complex regional pain syndrome severity score criteria. Only one of the patients diagnosed with complex regional pain syndrome required treatment for the complex regional pain syndrome. In all the other patients the features of complex regional pain syndrome settled spontaneously. Our results suggest that complex regional pain syndrome after distal radius fractures occurs less frequently than was previously reported. The International Association for the Study of Pain criteria and the complex regional pain syndrome severity scores showed similar sensitivity in early diagnosis of complex regional pain syndrome, but both are poor indicators of the need for treatment.

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