Effect of clinician’s experience and expertise on the inter-and intra-observer reliability of the computed tomography-based classification systems in posterior malleolus fractures
Acta Orthopaedica et Traumatologica Turcica, cilt.58, sa.3, ss.176-181, 2024 (SCI-Expanded, Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 58 Sayı: 3
- Basım Tarihi: 2024
- Doi Numarası: 10.5152/j.aott.2024.23155
- Dergi Adı: Acta Orthopaedica et Traumatologica Turcica
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.176-181
- Anahtar Kelimeler: Posterior malleolus fracture, Computed tomography, Classification, Haraguchi, Bartonicek-Rammelt, Mason-Molloy, Interobserver, Intraobserver reliability
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective: Three computed tomography (CT)-based classifications, including Haraguchi, Bartoníček–Rammelt, and Mason–Molloy sys-tems, have been developed to better determine the characteristics of posterior malleolus fractures (PMFs). The aims of this study were (1) to determine the intra-and inter-observer reliability of the computed tomography-based classification systems and (2) to investigate the clinical experience and expertise on their reliabilities. Methods: Sixty-seven preoperative ankle CT scans of 67 adult patients with “ankle fracture with the involvement of the posterior malleo-lus”’’ were retrospectively identified. CT images were assessed by 10 observers with different levels of clinical experience from 2 different specialties, including orthopedics and radiology. The observers were asked to classify PMFs according to 3 CT-based classifications on 2 separate occasions with a 4-week interval. Cohen’s κ values were measured for 2 raters and Fleiss’ κ values were measured for 3 raters and more. Results: Overall, each classification had moderate to very good intraobserver reliability (κ = 0.41 to 0.95, P < .01) as well as moderate interobserver reliability for each of the 2 separate assessments (κ = 0.41 to 0.60, P < .01 for the first occasion; κ = 0.44 to 0.59, P < .01 for the second occasion). Interobserver agreement among the foot and ankle surgeons regarding the Haraguchi and Bartoníček classifications was substantial for both assessment periods, whereas there was a moderate agreement for the Mason classification. Orthopedic residents showed moderate interobserver agreement in each period for both Bartoníček and Mason classifications. Radiology experts illustrated slight and fair agreements in the 2 assessments for Mason classification, moderate agreement in both assessments for Haraguchi classifi-cation, and substantial to moderate agreement in the first and second assessments for Bartoníček classification, respectively. Conclusion: Computed tomography-based classification system for PMFs demonstrated moderate interobserver reliability as well as moderate to very good intraobserver reliability. Moreover, foot and ankle specialists exhibit enhanced K values for both inter and intra-observer reliability for each classification system, consistency seems to increase as the interest in the field condenses.