Validation of the Classification of Leonetti and Tigani in Tibial Pilon Fractures Through Resident Doctors in Traumatology and Orthopedics and Foot and Ankle Fellows
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Published:
Dec 20, 2023
Keywords:
Tibial pilon fractures, tomographic classification, interobserver agreement
Main Article Content
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.
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.
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How to Cite
Seletti, M., González, E., Pendino, A., Parma, J., & Derico, J. (2023). Validation of the Classification of Leonetti and Tigani in Tibial Pilon Fractures Through Resident Doctors in Traumatology and Orthopedics and Foot and Ankle Fellows. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(6), 601-605. https://doi.org/10.15417/issn.1852-7434.2023.88.6.1699
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Clinical Research
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References
1. 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
2. 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
3. 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
4. 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
5. 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
6. 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
7. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33(1):158-74. https://doi.org/10.2307/2529310
8. 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
9. Topliss CJ, Jackson M, Atkins RM. Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br
2005;87(5):692-7. https://doi.org/10.1302/0301-620X.87B5.15982
10. 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]
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
2. 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
3. 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
4. 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
5. 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
6. 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
7. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33(1):158-74. https://doi.org/10.2307/2529310
8. 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
9. Topliss CJ, Jackson M, Atkins RM. Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br
2005;87(5):692-7. https://doi.org/10.1302/0301-620X.87B5.15982
10. 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]
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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