Mohammad Abdul Hafidz YAKOB, SA Jamaludin, Ketan PANDE. Observer variation in ankle fracture classification amongst orthopaedic surgeons in Brunei Darussalam. Brunei Int Med J. 2014; 10 (6): 314-319

Observer variation in ankle fracture classification amongst orthopaedic surgeons in Brunei Darussalam

Mohammad Abdul Hafidz YAKOB ¹, SA Jamaludin ², Ketan PANDE ^1

1Department of Orthopaedics, and ² Department of General Surgery, RIPAS Hospital, Brunei Darussalam

ABSTRACT

Introduction: Classification systems can be used in the treatment of fractures to grade severity of injury, plan treatment, predict and compare results. Different classification systems are available for ankle fractures. These systems are subject to observer variation and have been studied with varying results. The aim of this study was to assess the observer variation of the Lauge-Hansen and AO Weber classification of ankle fractures and to assess the agreement regarding the use of a syndesmotic screw in treatment of ankle fractures. Materials and Methods: Antero-posterior and lateral radiographs of patients who have undergone surgery for ankle fractures were collected (n=30). Eight orthopaedic surgeons of varying experience graded the radiographs independently and their inter- and intra-observer agreement was assessed using the kappa statistic. Two assessment sessions were conducted three weeks apart and each session was preceded by a presentation of the fracture classifications studied. Results: The results were expressed as mean kappa value. For the Lauge-Hansen classification the inter-observer value was 0.58 and intra-observer value was 0.64 and for AO Weber the values were 0.65 and 0.77 respectively. For the use of syndesmotic screw the values were 0.34 and 0.59 respectively. Level of experience was noted to have no effect on the intra-observer variation. Conclusion: AO Weber classification had better observer agreement compared to Lauge-Hansen classification and should be preferred. The decision for using a syndesmotic screw should not be based on radiological findings alone.

Keywords: Observer variation, ankle fracture, AO Weber classification, Lauge-Hansen classification, Kappa statistic

Correspondence author: Mohammad Abdul Hafidz HJ YAKOB
Department of Orthopaedics, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam. Tel: +673 7160177. E mail: fizzy_83@hotmail.com

Brunei Int Med J. 2014; 10 (6): 314-319