An evaluation of the Herscovici classification for fractures of the medial malleolus. Issue 4 (December 2017)

• Record Type: Journal Article
• Authors: Aitken, Stuart A.; Johnston, Ian; Jennings, Angus C.; Chua, Ivan T.H.; Buckley, Richard E.
• Is Part Of: Foot and ankle surgery. Volume 23:Issue 4(2017:Dec.)
• Page Start: 317
• Page End: 320
• Publication Date: 2017-12
• Subjects: Medial malleolus -- Fracture -- Reliability -- Accuracy; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; Ankle -- surgery -- Periodicals; Foot -- surgery -- Periodicals; Ankle -- Surgery; Foot -- Surgery; Periodicals; Electronic journals; 617.58
• DOI: 10.1016/j.fas.2016.10.003
• Languages: English
• ISSNs: 1268-7731

Abstract

Highlights: We determined the reliability and accuracy of the Herscovici classification of medial malleolus fractures by examining the blinded radiographs of 130 patients with medial malleolus fractures. We held a consensus meeting where observers agreed on a final classification and this served as our reference standard. The classification system demonstrated moderate inter-observer reliability ( κ = 0.54, 95% CI 0.40–0.68) but substantial reproducibility ( κ = 0.64, 95% CI 0.51–0.79). During the consensus meeting, 24 fractures (18%) were deemed unclassifiable by a majority decision. Future work should focus on refining the Herscovici classification to improve its application in the clinical setting. Abstract: Background: Despite its use in the literature, the application of the Herscovici classification system for medial malleolus fractures has not been evaluated. Methods: We aimed to determine the reliability and accuracy of the Herscovici classification. The blinded radiographs of 130 patients were independently classified by four orthopaedic trauma surgeons. We held a consensus meeting where observers agreed on a final classification and this served as our reference standard. We used weighted kappa ( κ ) coefficients of agreement. Results: Twenty-four fractures (18%) were deemed unclassifiable. The classification system demonstrated moderate inter-observer reliability ( κ = 0.54, 95% CI 0.40–0.68) but substantial reproducibility ( κ = 0.64, 95% CI 0.51–0.79). Accuracy, when compared with the reference standard, was κ = 0.54 (95% CI 0.40–0.66). Conclusions: The obliquity of the fracture line, and fracture extension, created difficulty in classification in 26% of cases. 18% of our cases could not be classified by majority decision. Our results emphasise the challenges faced in classifying these fractures. Future work should focus on refining the Herscovici classification.