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 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 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.

scholarly journals New Classification Based on CT and Its Value Evaluation for Fractures of the Lateral Process of the Talus

2021 ◽  
Author(s):  
Yuchuan Wang ◽  
Xiangtian Deng ◽  
Yanbin Zhu ◽  
Zhongzheng Wang ◽  
Lei Fu ◽  
...  
Keyword(s):  
Classification System ◽  
Prognostic Value ◽  
Treatment Options ◽  
Intraobserver Reliability ◽  
Kappa Statistics ◽  
Type I ◽  
New Classification ◽  
Concomitant Injuries ◽  
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. The aim of this study was to propose a comprehensive CT-based classification system, and to evaluate its prognostic value, reliability and reproducibility.Material and Methods: We retrospectively reviewed 42 patients involving LTPF and clinical and radiographic evaluations were performed at an average follow-up of 35.9 months. In order to create a comprehensive classification, a panel of experienced orthopedic surgeons discussed the cases. All fractures were classified according to Hawkins, McCrory-Bladin and new proposed classification system by four 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. Average AOFAS score was 91.5 in the type Ia of new classification proposed, 86 in type Ib, 90.5 in type Ic, 89 in type IIa, 76.7 in type IIb, 76.6 in type IIc, 91.3 in type IId, and 83.5 in type IIe. 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: The new classification system is a comprehensive one that takes into account concomitant injuries and it shows good prognostic value with clinical outcomes. It is more reliable and reproducible and could be a useful tool for decision-making on treatment options for LTPFs.

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.

scholarly journals The Comprehensive AO CMF Classification System for Mandibular Fractures: A Multicenter Validation Study

2019 ◽  
Vol 12 (4) ◽  
pp. 254-265 ◽  
Author(s):  
Paul A. Mittermiller ◽  
Serena S. Bidwell ◽  
Florian M. Thieringer ◽  
Carl-Peter Cornelius ◽  
Amber W. Trickey ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Reliability ◽  
Fracture Morphology ◽  
Mandibular Fractures ◽  
Condylar Process ◽  
Accuracy Study ◽  
Level 3 ◽  
Comprehensive Classification ◽  
Level 2 ◽  
Condylar Neck

The AO CMF has recently launched the first comprehensive classification system for craniomaxillofacial (CMF) fractures. The AO CMF classification system uses a hierarchical framework with three levels of growing complexity (levels 1, 2, and 3). Level 1 of the system identifies the presence of fractures in four anatomic areas (mandible, midface, skull base, and cranial vault). Level 2 variables describe the location of the fractures within those defined areas. Level 3 variables describe details of fracture morphology such as fragmentation, displacement, and dislocation. This multiplanar radiographic image-based AO CMF trauma classification system is constantly evolving and beginning to enter worldwide application. A validation of the system is mandatory prior to a reliable communication and data processing in clinical and research environments. This interobserver reliability and accuracy study is aiming to validate the three current modules of the AO CMF classification system for mandible trauma in adults. To assess the performance of the system at the different precision levels, it focuses on the fracture location within the mandibular regions and condylar process subregions as core components giving only secondary attention to morphologic variables. A total of 15 subjects individually assigned the location and features of mandibular fractures in 200 CT scans using the AO CMF classification system. The results of these ratings were then statistically evaluated for interobserver reliability by Fleiss’ kappa and accuracy by percentage agreement with an experienced reference assessor. The scores were used to determine if the variables of levels 2 and 3 were appropriate tools for valid classification. Interobserver reliability and accuracy were compared by hierarchy of variables (level 2 vs. level 3), by anatomical region and subregion, and by assessor experience level using Kruskal-Wallis and Wilcoxon's rank-sum tests. The AO CMF classification system was determined to be reliable and accurate for classifying mandibular fractures for most levels 2 and 3 variables. Level 2 variables had significantly higher interobserver reliability than level 3 variables (median kappa: 0.69 vs. 0.59, p < 0.001) as well as higher accuracy (median agreement: 94 vs. 91%, p < 0.001). Accuracy was adequate for most variables, but lower reliability was observed for condylar head fractures, fragmentation of condylar neck fractures, displacement types and direction of the condylar process overall, as well as the condylar neck and base fractures. Assessors with more clinical experience demonstrated higher reliability (median kappa high experience 0.66 vs. medium 0.59 vs. low 0.48, p < 0.001). Assessors with experience using the classification software also had higher reliability than their less experienced counterparts (median kappa: 0.76 vs. 0.57, p < 0.001). At present, the AO CMF classification system for mandibular fractures is suited for both clinical and research settings for level 2 variables. Accuracy and reliability decrease for level 3 variables specifically concerning fractures and displacement of condylar process fractures. This will require further investigation into why these fractures were characterized unreliably, which would guide modifications of the system and future instructions for its usage.

Reliability and application of the new morphological classification system for chronic symptomatic osteoporotic thoracolumbar fracture

2020 ◽  
Author(s):  
Ding-Jun Hao ◽  
Jun-Song Yang ◽  
Yuan Tuo ◽  
Chao-Yuan Ge ◽  
Bao-Rong He ◽  
...  
Keyword(s):  
Classification System ◽  
Dynamic Instability ◽  
Interobserver Reliability ◽  
Fracture Morphology ◽  
Thoracolumbar Fracture ◽  
Initial Assessment ◽  
Imaging Data ◽  
New Classification ◽  
Wide Clinical Application ◽  
Standard Classification

Abstract ObjectiveThis study proposed a new classification system for Chronic Symptomatic Osteoporotic Thoracolumbar Fracture (CSOTF) based on fracture morphology. Research on CSOTF has increased in recent years. However, the lack of a standard classification system has resulted in inconveniences regarding communication, research and treatment. Previous studies of CSOTF classification exhibit different defects, and none of these studies are widely accepted.MethodsWe collected 368 cases of CSOTF in our hospital from January 2010 to June 2017 and systematically analyzed the imaging data of all patients to develop a classification system. Imaging examinations included dynamic radiography, computed tomography scans and magnetic resonance imaging. Ten investigators systematically studied and fully understood the classification system grading 40 cases on two occasions, examined 1 month apart. Kappa coefficients (κ) were calculated to determine intraobserver and interobserver reliability.ResultsThe new classification system for CSOTF was divided into types I-V according to whether the CSOTF exhibited dynamic instability, spinal stenosis or kyphosis deformity. Intra- and interobserver reliability were excellent for all types (κ = 0.83 and 0.85, respectively).ConclusionsThe new classification system for CSOTF demonstrated excellent reliability in this initial assessment. The system is convenient for communication and research, but wide clinical application are needed to confirm its effectiveness and guide clinical treatment.

A Classification-System Improves the Intra- and Interobserver Reliability of Radiographic Diagnosis of “Pistol-Grip-Deformity”

2011 ◽  
Vol 21 (6) ◽  
pp. 732-739 ◽  
Author(s):  
Ingmar Ipach ◽  
Eva-Maria Arlt ◽  
Falk Mittag ◽  
Beate Kunze ◽  
Petra Wolf ◽  
...  
Keyword(s):  
Lower Limit ◽  
Classification System ◽  
Interobserver Reliability ◽  
Alpha Angle ◽  
Treatment Algorithm ◽  
Kappa Coefficient ◽  
Intraobserver Agreement ◽  
Single Plane ◽  
Upper Limit

Early detection of pistol-grip-deformity may be beneficial in optimising the outcome and the cost effectiveness of surgery. It is important to identify reliable radiographic parameters in assessing femoro-acetabular impingement (FAI) to develop a treatment algorithm. Radiographs of 47 patients ranging from “pistol grip deformity” to a normal head-neck-junction were measured for alpha angle and head ratio, and then classified by two different observers. The Bland-Altman plot was used for inter- and intraobserver agreement of alpha angle and head ratio. Inter- and intraobserver agreement for classification of “pistol grip deformity” was determined using weighted Cohen's kappa coefficient. Observer I achieved a kappa coefficient of 0.97. Observer II achieved a kappa coefficient of 0.92. An interobserver kappa coefficient between 0.87 and 0.92 was achieved by using a classification system. By testing for interobserver agreement, a bias of –0.004 with an upper limit of 0.461 and a lower limit of –0.47 was seen for the ratio and a bias of –3.7 with an upper limit of 17.2 and a lower limit of –24.6 for the alpha angle. Therefore, poor results were seen for intra- and interobserver reliability by using only a single plane for classification of “pistol grip deformity”. The strength of agreement could be improved by using a classification system (based on two planes).

scholarly journals A new classification of talocalcaneal coalitions based on computed tomography for operative planning

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Anhong Wang ◽  
Weili Shi ◽  
Lixiang Gao ◽  
Linxin Chen ◽  
Xing Xie ◽  
...  
Keyword(s):  
Classification System ◽  
Main Type ◽  
Interobserver Reliability ◽  
Weighted Kappa ◽  
Type I ◽  
Type Ii ◽  
New Classification ◽  
Type Iv ◽  
Talocalcaneal Coalition ◽  
Operative Planning

Abstract Background Current classifications emphasize the morphology of the coalition, however, subtalar joint facets involved should also be emphasized. Objective The objective of this study was to develop a new classification system based on the articular facets involved to cover all coalitions and guide operative planning. Methods Patients were diagnosed with talocalcaneal coalition using a CT scan, between January 2009 and February 2021. The coalition was classified into four main types according to the shape and nature of the coalition: I, inferiorly overgrown talus or superiorly overgrown calcaneus; II, both talus and calcaneus overgrew; III, coalition with an accessory ossicle; IV, complete osseous coalition (I-III types are non-osseous coalition). Then each type was further divided into three subtypes according to the articular facets involved. A, the coalition involving the anterior facets; M, the coalition involving the middle facets, and P, the coalition involving the posterior facets. Interobserver reliability was measured at the main type (based on nature and shape) and subtype (articular facet involved) using weighted Kappa. Results There were 106 patients (108 ft) included in this study. Overall, 8 ft (7.5%) were classified as type I, 75 ft (69.4%) as type II, 7 ft (6.5%) as type III, and 18 ft (16.7%) as type IV. Twenty-nine coalitions (26.9%) involved the posterior facets only (subtype-P), 74 coalitions (68.5%) involved both the middle and posterior facets (subtype-MP), and five coalitions (4.6%) simultaneously involved the anterior, middle, and posterior facets (subtype-AMP). Type II-MP coalition was the most common. The value of weighted Kappa for the main type was 0.93 (95%CI 0.86–0.99) (p<0.001), and the value for the subtype was 0.78 (95%CI 0.66–0.91) (p<0.001). Conclusion A new classification system of the talocalcaneal coalition to facilitate operative planning was developed.

RELIABILITY OF LICHTMAN'S CLASSIFICATION FOR KIENBÖCK'S DISEASE IN 99 SUBJECTS

Hand Surgery ◽  
2011 ◽  
Vol 16 (01) ◽  
pp. 15-18 ◽  
Author(s):  
Masaki Shin ◽  
Masahiro Tatebe ◽  
Hitoshi Hirata ◽  
Shukuki Koh ◽  
Takaaki Shinohara
Keyword(s):  
Classification System ◽  
Wrist Joint ◽  
Interobserver Reliability ◽  
Clinical Settings ◽  
X Rays ◽  
New Classification ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

Purpose: The objective of this research was to investigate the reliability of Lichtman's classification for Kienböck's disease. Methods: Interobserver reliability and intraobserver reproducibility were investigated by interpreting both anteroposterior and lateral X-rays of the wrist joint twice in 99 patients with Kienböck's disease using the modified Lichtman's classification system. Observers comprised three orthopaedic surgeons, and no information was exchanged between observers either before or during the study. Results: Intraobserver reliability was moderate (0.313–0.628), and interobserver reliability was fair (Siegel's kappa = 0.228). Conclusion: Low values were obtained regarding interobserver reliability for the modified Lichtman's classification of Kienböck's disease. This classification is thus inadequate for use in clinical settings. A new classification should be established.

scholarly journals The arteriovenous access stage (AVAS) classification

2020 ◽  
Author(s):  
Peter Baláž ◽  
Jennifer Hanko ◽  
Hannah Magowan ◽  
Agnes Masengu ◽  
Katarina Lawrie ◽  
...  
Keyword(s):  
Vascular Access ◽  
Classification System ◽  
Sample Size Calculation ◽  
Vascular Anatomy ◽  
New Classification ◽  
Rater Reliability ◽  
Surgical Access ◽  
Kappa Value ◽  
Arteriovenous Access ◽  
Share Information

Abstract Background Key anatomical factors mean that individuals needing arteriovenous access are unique and have different possibilities for fistula creation. The aim of this article is to describe a new classification system for all patients needing haemodialysis vascular access in the upper extremity with the purpose to simplify sharing the information about suitability for surgical access creation depending on vascular anatomy. Methods According to the patient’s vascular anatomy in right and left superior extremities, patients were separated into three arteriovenous access stages (AVAS). The AVAS was validated by three blinded observers using a sample of 70 upper limb arteriovenous maps that were performed using ultrasound on patients referred for vascular access assessment. A sample size calculation was performed and calculated that for three observers, a minimum of 67 maps were required to confirm significant agreement at a Kappa value of 0.9 (95% confidence interval 0.75–0.99). Results The Kappa value for inter-rater reliability using Fleiss’ Kappa coefficient was 0.94 and all patients fitted into the AVAS classification system. Conclusion The AVAS classification system is a simplified way to share information about vascular access options based on a patient’s vascular anatomy with high inter-rater reliability.

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