title: AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement.
abstract: BackgroundThe primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter- and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty.MethodsA randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web-based portal by an invited group of participants on two occasions.ResultsInterobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra-rater reproducibility was "substantial" for fracture types and "fair" for fracture groups with no difference accounting for location, training level, or specialty.ConclusionImproved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize.Level of EvidenceLevel III.
authors.affiliation: Department of General Surgery, OLVG, Amsterdam, The Netherlands.
authors.forename: Prakash
authors.initials: P
authors.lastname: Jayakumar
authors.affiliation: Department of General Surgery, OLVG, Amsterdam, The Netherlands.
authors.forename: Teun
authors.initials: T
authors.lastname: Teunis
authors.affiliation: Orthopaedic Upper Extremity Service, Hospital Universitario Doce de Octubre-Universidad Complutense, Madrid, Spain.
authors.forename: Beatriz Bravo
authors.initials: BB
authors.lastname: Giménez
authors.affiliation: Department of Hand Surgery, Monica Hospital/Antwerp University Hospital, Edegem, Belgium.
authors.forename: Frederik
authors.initials: F
authors.lastname: Verstreken
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Barts and The Royal London Hospital, London, United Kingdom.
authors.forename: Livio
authors.initials: L
authors.lastname: Di Mascio
authors.affiliation: Department of General Surgery, OLVG, Amsterdam, The Netherlands.
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
keywords: classification; distal radius fracture; reliability; reproducibility