Evaluation of the Reproducibility of Lauge-Hansen, Danis-Weber, and AO Classifications for Ankle Fractures

Ramos, Lucas Sacramento; Gonçalves, Henrique Mansur; Freitas, Anderson; Oliveira, Marcio de Paiva; Lima, Diogo Marcelino Santos; Carmargo, Welvis Soares

doi:10.1055/s-0040-1718508

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Sumário

Original Articles, Trauma • Rev. bras. ortop. 56 (3) • May-Jun 2021 • https://doi.org/10.1055/s-0040-1718508 copy

Evaluation of the Reproducibility of Lauge-Hansen, Danis-Weber, and AO Classifications for Ankle Fractures^* * Study developed by the Orthopedics and Traumatology Service of the Hospital Regional do Gama, DF, Brazil, and by the Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE-HOME-DF, in the Portuguese acronym) Brasília, DF, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present study aims to analyze the intra- and interobserver reproducibility of the Lauge-Hansen, Danis-Weber, and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classifications for ankle fractures, and the influence of evaluators training stage in these assessments.

Methods

Anteroposterior (AP), lateral and true AP radiographs from 30 patients with ankle fractures were selected. All images were evaluated by 11 evaluators at different stages of professional training (5 residents and 6 orthopedic surgeons), at 2 different times. Intra- and interobserver agreement was analyzed using the weighted Kappa coefficient. Student t-tests for paired samples were applied to detect significant differences in the degree of interobserver agreement between instruments.

Results

Intraobserver analysis alone had a significant agreement in all classifications. Moderate to excellent interobserver agreement was highly significant (p ≤ 0.0001) for the Danis-Weber classification. The Danis-Weber classification showed, on average, a significantly higher degree of agreement than the remaining classification systems (p ≤ 0.0001).

Conclusion

The Danis-Weber classification presented the highest reproducibility among instruments and the evaluator's little experience had no negative influence on the reproducibility of ankle fracture classifications. Level of Evidence II, Diagnostic Studies - Investigating a Diagnostic Test.

Keywords
ankle fractures; classification; reproducibility of results

Sample^* * Kappa-weighted statistical sample.	Instrument	M1					M2
		mean		SD	instrument pairs	p value^a a Student t test for paired samples.	mean		SD	instrument pairs	p value^a a Student t test for paired samples.
Total (n = 55)	W (1)	0.81	±	0.11	1 vs 2	< 0.0001	0.79	±	0.11	1 vs 2	< 0.0001
	LG (2)	0.43	±	0.21	1 vs 3	< 0.0001	0.52	±	0.18	1 vs 3	< 0.0001
	AO (3)	0.43	±	0.19	2 vs 3	0.83	0.48	±	0.21	2 vs 3	0.18
only among specialists (n = 15)	W (1)	0.76	±	0.10	1 vs 2	< 0.0001	0.79	±	0.13	1 vs 2	< 0.0001
	LG (2)	0.29	±	0.15	1 vs 3	< 0.0001	0.49	±	0.15	1 vs 3	< 0.0001
	AO (3)	0.30	±	0.17	2 vs 3	0.82	0.41	±	0.27	2 vs 3	0.15
only among residents (n = 10)	W (1)	0.86	±	0.08	1 vs 2	0.0008	0.76	±	0.08	1 vs 2	0.003
	LG (2)	0.59	±	0.19	1 vs 3	0.0001	0.54	±	0.18	1 vs 3	0.0005
	AO (3)	0.61	±	0.10	2 vs 3	0.85	0.54	±	0.12	2 vs 3	0.84
specialists vs residents (n = 30)	W (1)	0.82	±	0.11	1 vs 2	< 0.0001	0.80	±	0.11	1 vs 2	< 0.0001
	LG (2)	0.44	±	0.20	1 vs 3	< 0.0001	0.52	±	0.20	1 vs 3	< 0.0001
	AO (3)	0.44	±	0.18	2 vs 3	0.99	0.50	±	0.21	2 vs 3	0.61

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Lucas Sacramento Ramos, SQS 214, bloco C, apartamento 605, Asa Sul, Brasília, DF, 70293-030, Brazil (e-mail: lucas.sacramentoramos@gmail.com).