Interobserver and intraobserver variations in tibial pilon fracture classification systems

Abstract

Background Tibial pilon injuries are a complex group of fractures, whose classification and radiological assessment has been under constant reform. Till date, there is no universally accepted classification system. Objective To determine the interobserver agreement and intraobserver reproducibility of Ruedi and Allgower, AO, and Topliss et al. classification systems for tibial pilon fractures, with CT scans. Method Forty-seven CT scans of tibial pilon fractures were evaluated independently by 5 orthopaedic surgeons. Fractures were classified according to Ruedi and Allgower, AO and Topliss et al. types. Assessment was done on two occasions, eight weeks apart. Results The interobserver reliability and intraobserver reproducibility for Ruedi and Allgower, AO and Topliss et al. classifications showed only moderate agreement. The interobserver agreement was dependent on the familiarity and specificity of the classification system. Conclusion Currently used classification systems for tibial pilon fracture have moderate interobserver and intraobserver agreements, even with the help of CT scans. Therefore Tibial pilon fracture classification still remains largely undetermined.