The Buttazzoni Classification of Distal Radial Fractures in Adults: Interobserver and Intraobserver Reliability

Abstract

Despite the fact that distal radial fracture is the commonest fracture, there is a little evidence-based knowledge about the value of its classification to guide management and predict prognosis. The available classification systems are either complicated or weakly applicable in clinical practice. Older's classification is the most reliable, but does not cover all radial fracture types. We evaluated the interobserver and intraobserver reliability of a new classification system which is a modification of Older's classification covering all radial fracture types. Two hundred and thirty-two consecutive adult patients with acute distal radial fractures were blindly evaluated according to the new classification by three orthopedic surgeons twice with 1-year interval. The interobserver reliability was measured using the Fleiss kappa coefficient, and the intraobserver reliability was measured using the Cohen's kappa coefficient. The new classification showed fair to substantial interobserver and intraobserver reliability, i.e., results comparable to the reliability of commonly used classification systems. The reliability was better for younger patients and when evaluation was carried out by handsurgery-interested orthopedic surgeons. The new classification system is simple, covers all radial fracture types, and has an acceptable reliability. Further studies are needed to judge its ability to direct management and predict prognosis.

Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly

“…It describes the degree of dorsal displacement of the distal fragment, the degree of radial shortening and the degree of comminution of the dorsal cortex close to the fracture, as predictors of fracture instability. A further development of the Older classification is the recently introduced Buttazoni classification 10 , which is simpler and includes comminution of the volar cortex as a predictor of instability. A commonly used classification is the universal AO/OTA system 11 which describes three main types of fractures: (A) extraarticular, (B) partial intraarticular and (C) complete intraarticular, with subgroups within each main type.…”

Influence of Cortical Comminution and Intra-articular Involvement in Distal Radius Fractures on Clinical Outcome: A Prospective Multicenter Study

“…We found no statistically significant differences in QuickDASH, EQ-5D questionnaire, EQ-5D health status VAS, and pain VAS scores among the Buttazzoni classes. Surgical technique differed among the fracture classes (►Table 7). No B0 and only one B1 fracture were treated surgically.…”

“…23 The utility of this system by testing its interobserver reliability and intraobserver reproducibility was previously reported. 7 In a prospective multicenter clinical trial, the ability of the system to predict radiological stability was tested, and revealed that fractures with initially nonacceptable radiographic alignment and cortical comminution were highly unstable. 8 In this study, we aimed to evaluate the effect of dorsal and volar comminution, intra-articular involvement, and initial displacement on clinical outcome.…”

“…This level of agreement was only reached for two of the three observers and only in younger patients when the classification was evaluated 2009. 7 Therefore, the reliability of the classification system may be a limitation. Despite this, the classification was highly predictive of fracture instability.…”

“…The interobserver reliability and intraobserver reproducibility of the Buttazzoni's classification were fair to substantial. 7 Furthermore, the Buttazzoni's classification could predict the radiographic outcome. 8 Volar comminution was highly associated with fracture instability.…”