Ankle fractures. The Lauge-Hansen classification revisited.

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Abstract

[Indexed for MEDLINE] 20. Skeletal Radiol. 2015 Oct;44(10):1435-9. doi: 10.1007/s00256-015-2179-4. Epub 2015 Jun 9. Interobserver variation in classification of malleolar fractures. Verhage SM(1), Rhemrev SJ, Keizer SB, Quarles van Ufford HM, Hoogendoorn JM. Author information: (1)Department of Surgery, MC Haaglanden, The Hague, The Netherlands, sanverhage@hotmail.com. OBJECTIVE: Classification of malleolar fractures is a matter of debate. In the ideal situation, a classification system is easy to use, shows good inter- and intraobserver agreement, and has implications for treatment or research. MATERIAL AND METHODS: Interobserver study. Four observers distributed 100 X-rays to the Weber, AO and Lauge-Hansen classification. In case of a trimalleolar fracture, the size of the posterior fragment was measured. Interobserver agreement was calculated with Cohen's kappa. Agreement on the size of the posterior fragment was calculated with the intraclass correlation coefficient. RESULTS: Moderate agreement was found with all classification systems: the Weber (K = 0.49), AO (K = 0.45) and Lauge-Hansen (K = 0.47). Interobserver agreement on the presence of a posterior fracture was substantial (K = 0.63). Estimation of the size of the fragment showed moderate agreement (ICC = 0.57). CONCLUSION: Classification according to the classical systems showed moderate interobserver agreement, probably due to an unclear trauma mechanism or the difficult relation between the level of the fibular fracture and syndesmosis. Substantial agreement on posterior malleolar fractures is mostly due to small (