title: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedics, James Cook University Hospital, Middlesbrough TS4 3BW, United Kingdom. manjuramappa@doctors.org.uk
authors.forename: Manjunath
authors.initials: M
authors.lastname: Ramappa
authors.forename: Ali
authors.initials: A
authors.lastname: Bajwa
authors.forename: Anjani
authors.initials: A
authors.lastname: Singh
authors.forename: Paul
authors.initials: P
authors.lastname: Mackenney
authors.forename: Anthony
authors.initials: A
authors.lastname: Hui
authors.forename: Andrew
authors.initials: A
authors.lastname: Port
mesh_terms: D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results; D013978:Tibial Fractures / Q000145:classification* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices