Highlights
- •A skeletal defects classification scheme is an important step towards standardising the assessment of these complex injuries.
- •Interobserver reliability testing demonstrated the proposed classification system had substantial agreement between observers.
- •Intraobserver variability showed a range of substantial to almost perfect agreement of each observer following a three-week interval.
- •The classification scheme is based primarily on conventional orthogonal radiographs, requiring no sophisticated technology or elaborate calculations.
- •The distinction between the various elements of the classification scheme are consistent with the prior orthopaedic trauma literature.
Abstract
Objectives
To clinically validate a recently proposed classification scheme of post-traumatic
bone defects.
Methods and materials
Open fractures were classified utilising a newly introduced classification system.
This classification system is based on plain radiographs, assessing the extent and
local geometry of bone loss, including: D1 - Incomplete Defects; D2 - Minor/Sub-Critical
(Complete) Defects (<2 cm); and D3 - Segmental/Critical Sized Defects (2 cm). Reliability was assessed among six independent assessors (three trauma orthopaedic
surgeons and three orthopaedic training surgeons) using Fleiss’ kappa tests. 43 open
fractures from a tertiary referral trauma centre and their radiographic series were
analysed.
Results
Interobserver reliability testing demonstrated the proposed classification system
had substantial agreement between the 6 observers, κ = 0.623 (z = 33.8), p < 0.001. Intraobserver variability showed a range of substantial to almost perfect
agreement of each observer following a three-week interval between repeat assessments,
κ range 0.69–0.914, p < 0.001.
Conclusions
In this representative validation cohort there was substantial agreement between observers
when assessing a diverse range of bone defects following long bone open trauma, with
highly reproducible assessments by both orthopaedic surgeons and trainee orthopaedic
surgeons alike on an internal level. The classification scheme is based on conventional
orthogonal radiographs and requires no sophisticated technology, and is therefore
pragmatic and applicable to secondary, tertiary and quaternary levels of care for
trauma patients.
Level of Evidence
III
Keywords
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Article info
Publication history
Published online: August 13, 2022
Accepted:
August 12,
2022
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier Ltd. All rights reserved.
