title: Intra- and interobserver agreement on the Oestern and Tscherne classification of soft tissue injury in periarticular lower-limb closed fractures.
abstract: BACKGROUND
  The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation.
  
  
  OBJECTIVE
  The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification.
  
  
  METHODS
  This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories.
  
  
  RESULTS
  Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86).
  
  
  CONCLUSIONS
  Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies.
authors.affiliation: Hospital Pablo Tobón Uribe, Medellín, Colombia ; Universidad de Antioquia, Medicine School, Rehabilitation in Health Group, Medellín, Colombia ; Universidad de Antioquia, Medicine School, Clinical Epidemiology Academic Group, Medellín, Colombia.
authors.forename: Carlos Oliver
authors.initials: CO
authors.lastname: Valderrama-Molina
authors.affiliation: Hospital Pablo Tobón Uribe, Medellín, Colombia.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Estrada-Castrillón
authors.affiliation: Universidad de Antioquia, Medicine School, Rehabilitation in Health Group, Medellín, Colombia ; Universidad de Antioquia, Medicine School, Clinical Epidemiology Academic Group, Medellín, Colombia.
authors.forename: Jorge Andrés
authors.initials: JA
authors.lastname: Hincapie
authors.affiliation: Universidad de Antioquia, Medicine School, Rehabilitation in Health Group, Medellín, Colombia ; Universidad de Antioquia, Medicine School, Clinical Epidemiology Academic Group, Medellín, Colombia.
authors.forename: Luz Helena
authors.initials: LH
authors.lastname: Lugo-Agudelo
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005596:Fractures, Closed / Q000145:classification* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D017695:Soft Tissue Injuries / Q000145:classification* / Q000473:pathology; D013978:Tibial Fractures / Q000145:classification* / Q000473:pathology; D013997:Time Factors; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Reliability; Soft tissue injuries; classification; tibial fractures