Total talar fracture – Inter- and intra-observer reproducibility of two classification systems (Hawkins and AO) for central talar fractures - 21/05/12

Doi : 10.1016/j.otsr.2012.04.011

T. Williams ^a, N. Barba ^b, T. Noailles ^c, V. Steiger ^d, V. Pineau ^e, G. Carvalhana ^f, B. Le Jacques ^a, A. Clave ^a, D. Huten ^b,^⁎
^a Service de chirurgie orthopédique, hôpital de la Cavale-Blanche, CHU, boulevard Tanguy-Prigent, 29200 Brest cedex, France
^b Service de chirurgie orthopédique, hôpital Sud, CHU, boulevard de Bulgarie, 35200 Rennes cedex 2, France
^c Service de chirurgie orthopédique, CHU Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex, France
^d Département chirurgie orthopédique, CHU, 4, rue Larrey, 49933 Angers cedex, France
^e Département d’orthopédie, CHU Côte-de-Nacre, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
^f Service de chirurgie orthopédique, hôpital Charles-Nicolle, CHU, Pavillon Dève, l, rue de Germont, 76031 Rouen cedex, France

Corresponding author. Tel.: +33 02 99 26 71 67.

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En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Monday 21 May 2012
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Summary

Introduction

We evaluated the inter- and intra-observer reproducibility of two classification systems for central talar fractures (Hawkins, as modified by Canal and Kelly and then by us; AO/AOT).

Hypothesis

The analysis and classification of these fractures will be better with CT scans than with X-rays.

Material and Methods

Four observers evaluated 39 X-ray and CT scan files twice in the span of six weeks; each evaluation entailed classifying the fractures and describing their main features. Cohen’s Kappa coefficient for inter-rater agreement was calculated and analysed.

Results

The inter- and intra-observer reproducibility with CT scans was better with X-rays for most of the parameters evaluated. The modified Hawkins classification provided better reproducibility than the AO/AOT one. However, this classification system was not perfect, even after modifications and use of CT scans.

Discussion

CT scans are an essential tool for the analysis of all talar fractures. We modified the Hawkins classification (as modified by Canal and Kelly) to include a Type 0 (no displacement or less than 2mm), include frontal body fractures that are displaced like neck fractures and take into account comminuted fractures and other trauma in the area.

Level of proof

IV – retrospective clinical study.

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Keywords : Talus, Fracture, Classification, CT scan, X-rays, Inter- and intra-observer reproducibility

MeSH terms : Humans, Talus, Tomography, X-Ray computed/methods, Observer variation, Reproducibility of results, Retrospective studies, Fractures/classification, Fractures/radiography