Weber Ankle Fracture Classification System Yields Greatest Interobserver and Intraobserver Reliability Over AO/OTA and Lauge-Hansen Classification Systems Under Time Constraints in an Asian Population

Glen, Liau Zi Qiang; Wong, Joel Yat Seng; Tay, Wei Xuan; Li, Tian Pei; Phua, Sean Kean Ann; Manohara, Ruben; Chee, Yu Han

doi:10.1053/j.jfas.2022.12.004

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…Type C fractures may also entail medial malleolus fractures or triangular ligament fractures, with all three types often accompanied by posterior malleolus fractures. Notably, type C fracture represents the most severe form of ankle joint fracture, often involving interosseous membrane tears and lower tibiofibular ligament injuries ( 22 , 23 ). Owing to the thin soft tissue around the ankle joint and its poor blood flow, the capillaries of the surrounding soft tissue rupture after a fracture, the permeability of the vascular wall increases, and the intravascular fluid penetrates the tissue gap, resulting in soft tissue swelling.…”

Section: Discussionmentioning

confidence: 99%

Calcaneal distraction vs. cast immobilization for the preoperative treatment of patients with Danis–Weber type C ankle fractures: a case–control study

Song,

Shi,

et al. 2024

Front. Surg.

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IntroductionAnkle fractures require temporary fixation to allow swelling to subside prior to surgery; this is typically achieved using calcaneal distraction or cast immobilization. We compared the results of these methods in the treatment of Danis–Weber type C ankle fractures.MethodsThis retrospective study analyzed the data of 86 patients with Danis–Weber type C ankle fractures, of whom 40 underwent calcaneal distraction and 46 underwent cast immobilization. Clinical measures including preoperative detumescence time, daily swelling value, skin condition, and pain, SF-36 Health Survey (SF-36) score and ankle scores were compared between the two groups.ResultsBaseline characteristics did not differ significantly between the groups. Calcaneal distraction resulted in a lower preoperative detumescence time (6.22 ± 0.64 vs. 8.94 ± 0.82 days) and lower daily swelling values compared with cast immobilization, leading to a lower skin necrosis rate. Resting pain scores were significantly lower in the calcaneal distraction group than in the cast immobilization group at various postoperative time points (P < 0.05). Ankle function scores were higher in the calcaneal distraction group than in the cast immobilization group at 12 months postoperatively (P < 0.05), indicating improved outcomes. Additionally, the SF-36 quality of life scores of patients undergoing calcaneal distraction were notably superior to those in the cast immobilization group.DiscussionCalcaneal distraction is superior to cast immobilization in reducing soft tissue swelling, alleviating pain, and enhancing ankle function recovery in patients with Danis–Weber type C ankle fractures. Early calcaneal distraction upon hospital admission is recommended to optimize surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Calcaneal distraction vs. cast immobilization for the preoperative treatment of patients with Danis–Weber type C ankle fractures: a case–control study

Song,

Shi,

et al. 2024

Front. Surg.

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“…Assessment of reliability and accuracy is important and widely used in the evaluation of fracture classifications, such as ankle fracture, 8 , 11 , 12 pelvic fracture, 13 and femoral fracture. 14 Interobserver and intraobserver reliabilities refer to the classification agreement of various observers and the same observer in different time periods, respectively.…”

Section: Introductionmentioning

confidence: 99%

The Reliability and Accuracy of the Medial Malleolar Fracture Classification Based on 3D CT Reconstruction

Lü

Liu

Xie

et al. 2023

Orthopaedic Surgery

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Objective: There is a new medial malleolar fracture classification based on 3D CT reconstruction. However, there is no study assessing the reliability and accuracy of the new classification system and comparison between the new and the classic classification. This study aimed to compare the reliability and accuracy of the medial malleolar fracture classification based on 3D CT reconstruction and the Herscovici classification system. Methods:We retrospectively analyzed the consecutive ankle fractures in our hospital from January 2013 to September 2020. Five inexperienced and five experienced orthopedic surgeons were included as observers to assess 68 cases with medial malleolar fractures. Ten evaluators classified the cases according to the two classification systems. The reference results of each case were made by the consensus of three senior trauma surgeons. The interobserver reliability, intraobserver reliability, and accuracy were evaluated at an interval of 6 weeks using Fleiss's kappa (κ) statistics. Results:We found substantial interobserver and intraobserver reliability and 81.4% accuracy for the new classification, which was statistically superior to the Herscovici classification (P < 0.05). The reliability and accuracy of both classifications were similar in inexperienced and experienced groups, except for type III in the new classification. The interobserver reliability of type II was the best (P < 0.05), and the intraobserver reliability of IVc ranked the worst (P < 0.05) in the new classification. Conclusion:The reliability and accuracy of the new classification are superior to the Herscovici classification. Clinical experiences will not affect the assessment of both classification systems in most instances.

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Fracture Line Morphology and a Novel Classification of Pilon Fractures

Liu,

Piao,

Cui

et al. 2024

Orthopaedic Surgery

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ObjectiveCurrently, there is no research that includes a comprehensive three‐dimensional fracture mapping encompassing all types of Pilon fractures. Moreover, the existing classification systems for Pilon fractures exhibit only moderate to fair consistency and reproducibility. Additionally, some of these classification systems fail to accurately depict the morphological characteristics of the fractures. This study aimed to create a fracture map encompassing all types of Pilon fractures by three‐dimensional fracture mapping. In addition, this study conducted a finite element analysis of the normal ankle joint, and based on the distribution of fracture lines and the stress distribution at the distal tibia, proposed a new classification for Pilon fractures.MethodsA retrospective analysis of Pilon fractures in our hospital from January 2018 to January 2024 was performed. A total of two hundred forty‐four Pilon fractures were included, and their fracture lines were transcribed onto the tibia and fibula templates, and fracture maps and heat maps were created. A nonhomogeneous model of the ankle joint was constructed and verified, and the stress distribution on the distal tibia articular surface was measured and analyzed in three models (neutral, dorsiflexed, and plantarflexed model). Based on the fracture map and stress distribution, a five‐column classification system for Pilon fractures was proposed, and the intraobserver and interobserver reliability was calculated using Cohen and Fleiss k statistics.ResultThe fracture line on the distal tibia articular surface showed a V‐shaped distribution. One branch extended from the junction of the medial malleolar articular surface and the inferior tibial articular surface toward the medial malleolus. The other branch extended from the middle of the fibular notch to the posterior part of the medial ankle, toward the tibial shaft. The fibula fracture line mainly extended from the anterior and lower part of the lateral malleolus to the posterior and upper part. As evidenced by the neutral, dorsiflexed, and plantar flexion models, the stress on the posterolateral articular surface (posterolateral column) was low, while the majority of the stress was concentrated in the center. Three‐column fractures were the most common, followed by two‐column fractures. Using the five‐column classification, the K‐weighted values of interobserver and intraobserver analysis were 0.653 (p < 0.001) and 0.708 (p < 0.001), respectively.ConclusionsIn this study, the fracture line and morphological characteristics of Pilon fractures were analyzed in detail by three‐dimensional mapping. In addition, this study conducted a finite element analysis of the stress distribution on the distal tibial joint surface of the normal ankle joint. Moreover, a novel classification system was proposed to reflect these findings. The new classification not only exhibits greater consistency, facilitating accurate communication of fracture characteristics among surgeons, but also aids in understanding the mechanisms of injury and formulating surgical strategies.

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Weber Ankle Fracture Classification System Yields Greatest Interobserver and Intraobserver Reliability Over AO/OTA and Lauge-Hansen Classification Systems Under Time Constraints in an Asian Population

Cited by 4 publications

References 30 publications

Calcaneal distraction vs. cast immobilization for the preoperative treatment of patients with Danis–Weber type C ankle fractures: a case–control study

Calcaneal distraction vs. cast immobilization for the preoperative treatment of patients with Danis–Weber type C ankle fractures: a case–control study

The Reliability and Accuracy of the Medial Malleolar Fracture Classification Based on 3D CT Reconstruction

Fracture Line Morphology and a Novel Classification of Pilon Fractures

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