Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility.

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Abstract

[Indexed for MEDLINE] 17. J Hand Surg Glob Online. 2025 Dec 24;8(2):100910. doi: 10.1016/j.jhsg.2025.100910. eCollection 2026 Mar. Distal Radius Fracture Classifications in Real Life: Reliability and How They Change Treatment. Nguyen SA(1)(2), Dang AH(1)(3), Tran DQ(1)(2). Author information: (1)Vietnam Military Medical University, Ha Noi City, Vietnam. (2)Institute of Orthopedics and Traumatology, Military Hospital 175, Ho Chi Minh City, Vietnam. (3)Joints Surgery Department, Trauma and Orthopaedics Center, Military Hospital 103, Ha Noi City, Vietnam. PURPOSE: To evaluate the reliability, clinical utility, and prognostic value of distal radius fracture (DRF) classification systems and to translate current evidence into a decision-oriented framework for everyday care. METHODS: We conducted a PRISMA-guided narrative review with structured searches of PubMed and Scopus (January 2010 to September 2025). Eligible adult studies assessed at least one DRF classification (eg, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association, Fernandez, Frykman, Melone, IDEAL) and reported reliability, clinical utility (treatment selection, complications/reoperation), or prognostic associations (patient-reported outcome measures, radiographic restoration). Study selection, extraction, and risk of bias assessment followed predefined procedures; data were synthesized thematically by imaging modality, rater expertise, and category granularity. RESULTS: Interobserver agreement was typically fair-moderate on radiographs; computed tomography yielded modest improvements. Increasing granularity (more categories/subcategories) consistently reduced κ/intraclass correlation coefficient, while a brief rater calibration session improved agreement. Across studies linking taxonomy to care, classification alone rarely changed management once radiographic thresholds of instability (shortening, tilt, intra-articular step-off) and patient factors (age/bone quality, functional demand) were applied. Prognostic associations between subtype and patient-reported outcome measures were inconsistent after adjustment for reduction quality. We operationalize these findings via reliability, morphology, age of bone, patient demands, yielding actionable pathways with explicit quality targets: restoration of radial height and tilt, intra-articular step-off ≤2 mm, and early motion. CONCLUSIONS: The DRF classifications remain valuable as a shared language and research scaffold, but their stand-alone reliability and prognostic power are limited. A pragmatic, reliability, morphology, age of bone, patient demands, yielding actionable pathway-based approach integrates classification with instability thresholds and patient factors to support auditable, evidence-based decisions. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V. © 2025 The Authors. DOI: 10.1016/j.jhsg.2025.100910 PMCID: PMC12799778