1, 6 In addition, we suggest that they should be simple, easy to remember and have acceptable interobserver agreement (reliability), intra-observer agreement (reproducibility) and validity. The purpose of any classification system should be to name and describe characteristics in an easy to follow universal language, to allow ordering into hierarchy, to guide action or intervention and to predict the potential outcomes of an intervention. From the 15 acknowledged classification systems, 7 were excluded on the basis of absence of reliability and reproducibility studies assessing them. A Medline, Ovid and National Library for Health keyword search was performed to identify from within the 15 classification systems those that had been subjected to formal reliability and reproducibility studies using kappa statistics. There have been 15 acknowledged classifications systems documented in primary literature for adult distal radius fractures in the past 70 years ( Fig 1), as referenced by the International Distal Radius Fracture Study Group. The value of classification systems varies considerably and an unhelpful classification system can serve as a conduit for miscommunication, offers little clinical application and soon transpires to be a tool for learning by humiliation. 5 However, eponyms provide limited information regarding fracture stability, treatment and prognosis. 4 Smith, in 1847, classified volarly displaced fractures into three types, based on anatomical description. 3 Barton, in 1838, described intra-articular fractures with either volar or dorsal displacement of the distal radius. In 1814, Colles described an extra-articular, dorsally displaced, metaphyseal fracture with radial shortening. The earliest classifications of distal radius fractures were with eponyms. Moreover, we would discourage trainees from spending time learning these classifications, as they serve not as essential clinical knowledge but more as forms of abstract memory testing.ĭistal radius fractures represent approximately 16% of all fractures managed by orthopaedic surgeons 1 They have a bimodal incidence, occurring in children with high energy trauma and in the elderly as a fragility fracture. Consequently, we would suggest that classification systems for acute adult distal radius fractures are not useful clinical knowledge but mainly historical and/or research tools. Failings range from poor reproducibility and reliability, and over-complexity mainly emanating from the inability to classify this spectrum of injury in all of its manifestations. Sadly, on completion of this paper we have not found a distal radius fracture classification that proved to be useful. For each classification, we give an insight into its history, strengths and weaknesses, and provide evidence from the literature on reliability and reproducibility. There are 15 described distal radius classification systems present in the literature in the past 70 years, of which 8 are discussed in this paper. They should be relevant, reproducible, reliable, properly validated and most importantly simple to use and understand. Classification systems should be tools for concise communication, which ideally can predict prognosis and guide treatment.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |