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Ankle Fracture Stability–Based Classification: A Study of Reproducibility and Clinical Prognostic Ability

Ankle Fracture Stability–Based Classification: A Study of Reproducibility and Clinical Prognostic... Objective: To compare the reproducibility and prognostic capacity of 2 commonly used ankle fracture classifications to the stability-based classification. Methods: One hundred ninety-three consecutive rotational-type ankle fractures treated during a year at our institution in patients older than 18 years were retrospectively analyzed. Pilon and pathologic fractures were excluded. The fractures were treated by attending physicians who were unaware of the stability-based classification system. Three observers classified injury radiographs using the Lauge-Hansen, Weber/AO, and stability-based classifications systems. Reproducibility (interobserver variation) of each classification system was calculated using kappa statistics. Prognostic values were evaluated by calculating the area under the curve for the receiver-operating characteristic curves (using surgery as the positive outcome). Results: The stability-based and Weber/AO classifications showed better reproducibility [kappa 0.938 (95% confidence interval 0.921–0.952), kappa 0.97 (0.961–0.976)], respectively, than the Lauge-Hansen [kappa 0.74 (0.664–0.795); P < 0.05]. The stability-based classification was more accurate (P < 0.001) in predicting surgical treatment [area under the curve 0.883 (95% confidence interval 0.852–0.914)] compared with the other 2 classifications [0.626 (0.576–0.675) and 0.698 (0.641–0.755)], respectively. Conclusions: The stability-based classification was both highly reproducible (kappa 0.938) and had superior prognostic capacity to identify patients who needed surgical intervention compared with both the Lauge-Hansen and AO/Weber classification systems. Importantly, there were no patients who were classified as stable who failed nonoperative treatment. This extends earlier studies by directly demonstrating its prognostic advantage to other classification systems. Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT. Reprints: James D. Michelson, MD, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, 418B Stafford Hall, 95 Carrigan Dr., Burlington, VT 05401 (e-mail: james.michelson@uvm.edu). The authors report no conflict of interest. Presented in part as a poster at the American Orthopaedic Foot & Ankle Society Summer Meeting, July 12, 2018, Boston, MA. Accepted April 24, 2019 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Orthopaedic Trauma Wolters Kluwer Health

Ankle Fracture Stability–Based Classification: A Study of Reproducibility and Clinical Prognostic Ability

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Publisher
Wolters Kluwer Health
ISSN
0890-5339
eISSN
1531-2291
DOI
10.1097/BOT.0000000000001507
Publisher site
See Article on Publisher Site

Abstract

Objective: To compare the reproducibility and prognostic capacity of 2 commonly used ankle fracture classifications to the stability-based classification. Methods: One hundred ninety-three consecutive rotational-type ankle fractures treated during a year at our institution in patients older than 18 years were retrospectively analyzed. Pilon and pathologic fractures were excluded. The fractures were treated by attending physicians who were unaware of the stability-based classification system. Three observers classified injury radiographs using the Lauge-Hansen, Weber/AO, and stability-based classifications systems. Reproducibility (interobserver variation) of each classification system was calculated using kappa statistics. Prognostic values were evaluated by calculating the area under the curve for the receiver-operating characteristic curves (using surgery as the positive outcome). Results: The stability-based and Weber/AO classifications showed better reproducibility [kappa 0.938 (95% confidence interval 0.921–0.952), kappa 0.97 (0.961–0.976)], respectively, than the Lauge-Hansen [kappa 0.74 (0.664–0.795); P < 0.05]. The stability-based classification was more accurate (P < 0.001) in predicting surgical treatment [area under the curve 0.883 (95% confidence interval 0.852–0.914)] compared with the other 2 classifications [0.626 (0.576–0.675) and 0.698 (0.641–0.755)], respectively. Conclusions: The stability-based classification was both highly reproducible (kappa 0.938) and had superior prognostic capacity to identify patients who needed surgical intervention compared with both the Lauge-Hansen and AO/Weber classification systems. Importantly, there were no patients who were classified as stable who failed nonoperative treatment. This extends earlier studies by directly demonstrating its prognostic advantage to other classification systems. Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT. Reprints: James D. Michelson, MD, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, 418B Stafford Hall, 95 Carrigan Dr., Burlington, VT 05401 (e-mail: james.michelson@uvm.edu). The authors report no conflict of interest. Presented in part as a poster at the American Orthopaedic Foot & Ankle Society Summer Meeting, July 12, 2018, Boston, MA. Accepted April 24, 2019

Journal

Journal of Orthopaedic TraumaWolters Kluwer Health

Published: Sep 1, 2019

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