title: Interobserver reliability of the young-burgess and tile classification systems for fractures of the pelvic ring.
abstract: OBJECTIVE
  The purpose of this study was to measure interobserver reliability of 2 classification systems of pelvic ring fractures and to determine whether computed tomography (CT) improves reliability. The reliability of several radiographic findings was also tested.
  
  
  METHODS
  Thirty patients taken from a database at a Level I trauma facility were reviewed. For each patient, 3 radiographs (AP pelvis, inlet, and outlet) and CT scans were available. Six different reviewers (pelvic and acetabular specialist, orthopaedic traumatologist, or orthopaedic trainee) classified the injury according to Young-Burgess and Tile classification systems after reviewing plain radiographs and then after CT scans. The Kappa coefficient was used to determine interobserver reliability of these classification systems before and after CT scan.
  
  
  RESULTS
  For plain radiographs, overall Kappa values for the Young-Burgess and Tile classification systems were 0.72 and 0.30, respectively. For CT scan and plain radiographs, the overall Kappa values for the Young-Burgess and Tile classification systems were 0.63 and 0.33, respectively. The pelvis/acetabular surgeons demonstrated the highest level of agreement using both classification systems. For individual questions, the addition of CT did significantly improve reviewer interpretation of fracture stability. The pre-CT and post-CT Kappa values for fracture stability were 0.59 and 0.93, respectively.
  
  
  CONCLUSIONS
  The CT scan can improve the reliability of assessment of pelvic stability because of its ability to identify anatomical features of injury. The Young-Burgess system may be optimal for the learning surgeon. The Tile classification system is more beneficial for specialists in pelvic and acetabular surgery.
authors.affiliation: Division of Orthopaedic Surgery; and daggerMartin Orthopaedic Biomechanics Lab, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Henry
authors.initials: H
authors.lastname: Koo
authors.forename: Mike
authors.initials: M
authors.lastname: Leveridge
authors.forename: Charles
authors.initials: C
authors.lastname: Thompson
authors.forename: Rad
authors.initials: R
authors.lastname: Zdero
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Kreder
authors.forename: David
authors.initials: D
authors.lastname: Stephen
authors.forename: Michael D
authors.initials: MD
authors.lastname: McKee
authors.forename: Emil H
authors.initials: EH
authors.lastname: Schemitsch
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data; D050723:Fractures, Bone / Q000145:classification* / Q000000981:diagnostic imaging*; D006801:Humans; D015588:Observer Variation; D010384:Pelvic Bones / Q000293:injuries*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000706:statistics & numerical data