Are distal radius fracture classifi cations reproducible? Intra and interobserver agreement

Authors

  • João Carlos Belloti Universidade Federal de São Paulo — Escola Paulista de Medicina
  • Marcel Jun Sugawara Tamaoki Universidade Federal de São Paulo — Escola Paulista de Medicina
  • Carlos Eduardo da Silveira Franciozi Universidade Federal de São Paulo — Escola Paulista de Medicina
  • João Baptista Gomes dos Santos Universidade Federal de São Paulo — Escola Paulista de Medicina
  • Daniel Balbachevsky Universidade Federal de São Paulo — Escola Paulista de Medicina
  • Eduardo Chap Chap Universidade Federal de São Paulo — Escola Paulista de Medicina
  • Walter Manna Albertoni Universidade Federal de São Paulo — Escola Paulista de Medicina
  • Flávio Faloppa Universidade Federal de São Paulo — Escola Paulista de Medicina

Keywords:

Colles’ fracture, Radius fractures, Classifi cation, Reproducibility of results, Validation studies

Abstract

CONTEXT AND OBJECTIVE: Various classifi cation systems have been proposed for fractures of the distal radius, but the reliability of these classifications is seldom addressed. For a fracture classification to be useful, it must provide prognostic signifi cance, interobserver reliability and intraobserver reproducibility. The aim here was to evaluate the intraobserver and interobserver agreement of distal radius fracture classifi cations. DESIGN AND SETTING: This was a validation study on interobserver and intraobserver reliability. It was developed in the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo — Escola Paulista de Medicina. METHOD: X-rays from 98 cases of displaced distal radius fracture were evaluated by fi ve observers: one third-year orthopedic resident (R3), one sixth-year undergraduate medical student (UG6), one radiologist physician (XRP), one orthopedic trauma specialist (OT) and one orthopedic hand surgery specialist (OHS). The radiographs were classifi ed on three different occasions (times T1, T2 and T3) using the Universal (Cooney), Arbeitsgemeinschaft für Osteosynthesefragen/ Association for the Study of Internal Fixation (AO/ASIF), Frykman and Fernández classifi cations. The kappa coeffi cient (κ) was applied to assess the degree of agreement. RESULTS: Among the three occasions, the highest mean intraobserver k was observed in the Universal classifi cation (0.61), followed by Fernández (0.59), Frykman (0.55) and AO/ASIF (0.49). The interobserver agreement was unsatisfactory in all classifi cations. The Fernández classifi cation showed the best agreement (0.44) and the worst was the Frykman classifi cation (0.26). CONCLUSION: The low agreement levels observed in this study suggest that there is still no classifi cation method with high reproducibility.

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Author Biographies

João Carlos Belloti, Universidade Federal de São Paulo — Escola Paulista de Medicina

MD, MSc, PhD. Attending physician in the Traumatology Sector, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo — Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.

Marcel Jun Sugawara Tamaoki, Universidade Federal de São Paulo — Escola Paulista de Medicina

Third-year resident in the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo — Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.

Carlos Eduardo da Silveira Franciozi, Universidade Federal de São Paulo — Escola Paulista de Medicina

Third-year resident in the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo — Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.

João Baptista Gomes dos Santos, Universidade Federal de São Paulo — Escola Paulista de Medicina

MD, PhD. Adjunct professor and head of Hand Surgery Clinic, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo — Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.

Daniel Balbachevsky, Universidade Federal de São Paulo — Escola Paulista de Medicina

MD. Attending physician in the Traumatology Sector, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo — Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.

Eduardo Chap Chap, Universidade Federal de São Paulo — Escola Paulista de Medicina

Sixth-year undergraduate, Universidade Federal de São Paulo — Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.

Walter Manna Albertoni, Universidade Federal de São Paulo — Escola Paulista de Medicina

MD, PhD. Titular professor of the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo — Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.

Flávio Faloppa, Universidade Federal de São Paulo — Escola Paulista de Medicina

MD, PhD. Titular professor and head of the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo — Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.

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Published

2008-05-05

How to Cite

1.
Belloti JC, Tamaoki MJS, Franciozi CE da S, Santos JBG dos, Balbachevsky D, Chap EC, Albertoni WM, Faloppa F. Are distal radius fracture classifi cations reproducible? Intra and interobserver agreement. Sao Paulo Med J [Internet]. 2008 May 5 [cited 2025 Mar. 14];126(3):180-5. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/1966

Issue

Vol. 126 No. 3 (2008)

Section

Original Article

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