Strategies in Trauma and Limb Reconstruction

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VOLUME 10 , ISSUE 3 ( November, 2015 ) > List of Articles

Original Article

Inter- and intra-observer agreement of the AO classification for operatively treated distal radius fractures

Jesse M. van Buijtenen, Mischa L. C. van Tunen, Wietse P. Zuidema, Emile A. Heilbron, Jeroen de Haan, Henrica C. W. de Vet, Robert J. Derksen

Keywords : Distal radius fracture, Surgical procedures, Intra-observer agreement, Inter-observer agreement, AO classification, C-type fractures

Citation Information : van Buijtenen JM, van Tunen ML, Zuidema WP, Heilbron EA, de Haan J, de Vet HC, Derksen RJ. Inter- and intra-observer agreement of the AO classification for operatively treated distal radius fractures. 2015; 10 (3):155-159.

DOI: 10.1007/s11751-015-0237-z

License: CC BY-NC-SA 4.0

Published Online: 01-12-2013

Copyright Statement:  Copyright © 2015; The Author(s).


The reproducibility of the AO classification for distal radius fractures remains a topic of debate. Previous studies showed variable reproducibility results. Important treatment decisions depend on correct classification, especially in comminuted, intra-articular fractures. Therefore, reliable reproducibility results need to be undisputedly determined. Hence, the study objective was to assess inter- and intra-observer agreement of the AO classification for operatively treated distal radius fractures. A database of 54 radiographs of all AO types (A, B and C) and groups (A2-3, B1-3, and C1-3) of distal radius fractures was assessed in twofold. Likewise, a subset of 152 radiographs of solely C-type groups (C1-3) was assessed. All fractures were classified by six observers with different experience levels: three consultant trauma surgeons, one sixth-year trauma surgery resident, a consultant trauma radiologist, and an intern with limited experienced. The inter-observer agreement of both main types and groups was moderate (κ = 0.49 resp. κ = 0.48) in combination with a good intra-observer agreement (κ = 0.68 resp. κ = 0.70). The inter-observer agreement of the subset C-type fractures group was fair (κ = 0.27) with moderate intra-observer agreement (κ = 0.43). According to these results, the reproducibility of the AO classification of main types and groups of distal radius fractures based on conventional radiographs is insufficient (κ < 0.50), especially at group level of C-type fractures.

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