Validation of the Classification of Leonetti and Tigani in Tibial Pilon Fractures Through Resident Doctors in Traumatology and Orthopedics and Foot and Ankle Fellows
Abstract
Objective: To validate the classification of Leonetti and Tigani with evaluators of different levels of expertise. Materials and Methods: 54 patients with 54 tibial pilon fractures were evaluated retrospectively. Patients were studied using AP and lateral radiography of the distal tibia, as well as CT scans (axial, coronal, and sagittal images with reconstruction). All subtypes of the Leonetti classification were included. The evaluators presented different levels of training: two Foot and Ankle fellows and two residents in their last year of training. To determine the interobserver agreement, each case was classified into types I, II, III and IV according to Leonetti. To determine the intraobserver agreement, the cases were analyzed by the same evaluator after 6 weeks. The kappa coefficient (k) was used to determine the degree of agreement between the evaluators, that value was expressed with a 95% confidence interval. Results: The intraobserver agreement between the first and second evaluation for fellows was moderate and very good. For the residents, it was good and very good. The interobserver agreement for the classification of tibial pilon fractures presented an overall kappa of 0.7156 (95%CI: 0.60 to 0.83), which is a good value when all fractures are considered by all evaluators. Conclusion: This tibial pilon fracture classification system surpasses previous studies of other classifications in terms of agreement. These agreements were reached with physicians with varying levels of expertise. Our findings contribute to the external and independent validation of this new classification system.Downloads
References
Helfet DL, Koval K, Pappas J, Sanders RW, DiPasquale T. Intraarticular “pilon” fracture of the tibia. Clin Orthop Relat Res 1994;(298):221-8. PMID: 8118979
Korkmaz A, Çiftdemir M, Özcan M, Çopuroglu C, Sarıdogan K. The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients. Injury 2013;44(10):1270-4.
https://doi.org/10.1016/j.injury.2013.06.016
Martin JS, Marsh JL, Bonar SK, DeCoster TA, Found EM, Brandser EA. Assessment of the AO/ASIF fracture classification for the distal tibia. J Orthop Trauma 1997;11(7):477-83. https://doi.org/10.1097/00005131-199710000-00004
Dirschl DR, Adams GL. A critical assessment of factors influencing reliability in the classification of fractures, using fractures of the tibial plafond as a model. J Orthop Trauma 1997;11(7):471-76.
https://doi.org/10.1097/00005131-199710000-00003
Leonetti D, Tigani D. Pilon fractures: A new classification system based on CT scan. Injury 2017(10);48:2311-7. https://doi.org/10.1016/j.injury.2017.07.026
Palma J, Villa A, Mery P, Abarca M, Mora A, Peña A, et al. A new classification system for pilon fractures based on CT scan: An independent interobserver and intraobserver agreement evaluation. J Am Acad Orthop Surg 2020;28(5):208-13. https://doi.org/10.5435/JAAOS-D-19-00390
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33(1):158-74. https://doi.org/10.2307/2529310
Swiontkowski MF, Sands AK, Agel J, Diab M, Schwappach JR, Kreder HJ. Interobserver variation in the AO/OTA fracture classification system for pilon fractures: Is there a problem? J Orthop Trauma 1997;11(7):467-70. https://doi.org/10.1097/00005131-199710000-00002
Topliss CJ, Jackson M, Atkins RM. Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br
;87(5):692-7. https://doi.org/10.1302/0301-620X.87B5.15982
Krettek C, Bachmann S. [Pilon fractures. Part 1: Diagnostics, treatment strategies and approaches]. Chirurg 2015;86(1):87-101; quiz 102-4. https://doi.org/10.1007/s00104-014-2895-7 [En alemán]
Tornetta P, Gorup J. Axial computed tomography of pilon fractures. Clin Orthop Relat Res 1996;(323):273-6. https://doi.org/10.1097/00003086-199602000-00037
Ramappa M, Bajwa A, Singh A, Mackenney P, Hui A, Port A. Interobserver and intraobserver variations in tibial pilon fracture classification systems. Foot 2010;20(2-3):61-3. https://doi.org/10.1016/j.foot.2010.06.002
Urrutia J, Zamora T, Yurac R, Campos M, Palma J, Mobarec S, et al. An independent interobserver reliability and intraobserver reproducibility evaluation of the new AOSpine thoracolumbar spine injury classification system. Spine (Phila Pa 1976) 2015;40(1):E54-E58. https://doi.org/10.1097/BRS.0000000000000656
Millar SC, Arnold JB, Thewlis D, Fraysse F, Solomon LB. A systematic literature review of tibial plateau fractures: What classifications are used and how reliable and useful are they? Injury 2018;49(3):473-90.
https://doi.org/10.1016/j.injury.2018.01.025
Urrutia J, Zamora T, Yurac R, Campos M, Palma J, Mobarec S, et al. An independent inter-and intraobserver agreement evaluation of the AOSpine subaxial cervical spine injury classification system. Spine (Phila Pa 1976) 2017;42(5):298-303. https://doi.org/10.1097/BRS.0000000000001302
Kristiansen B, Andersen UL, Olsen CA, Varmarken JE. The Neer classification of fractures of the proximal humerus. An assessment of interobserver variation. Skeletal Radiol 1988;17(6):420-2. 20.
https://doi.org/10.1007/BF00361661
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