A Comparison of Two Classification Systems for Pediatric Ankle Fractures

Background: A good fracture classification should provide information about fracture stability and fracture mechanism, and should be a guide for treatment selection with a high degree of reproducibility. The purpose of this study was to analyze the degree of reliability of the two most widely used classification systems for pediatric ankle fractures: The AO classification and the Dias-Tachdjian Classification. Methods: We studied 53 patients, 34 male and 19 female, with ankle fractures. Two classifications, the AO classification and the Dias-Tachdjian classification, were used. Two groups of assessors, one consisting of experienced surgeons and the other of fellows, were asked to classify the fractures. The Cohen Kappa index was used to measure interobserver reliability and to determine interobserver agreement, the Kappa value was deduced using the Fleiss method. Interobserver agreement was measured using the Fleiss kappa coefficient, and intraobserver reliability was measured using the Cohen’s kappa coefficient. Results: The intraobserver and interobserver agreement was not significantly different between the different groups of assessors. Conclusions: In the pediatric age different types of fractures and different mechanisms within an isolated fracture can be found. We found that many of these fracture patterns do not fit in any of the two classifications, which are thus unproductive for surgical planning.


Baroni Eduardo, Miscione Fernando, Dello Russo Bibiana

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