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Abstract
Five different radiographs of distal radial fractures were classified according to
the AO/ASIF, Frykman, Fernandez and Older systems by 45 observers (trauma surgeons
and residents). The same panel classified the same radiographs in a different order
4 months later. Mean interobserver correlation for all cases was fair to moderate
according to the Spearman rank test. However, these classifications showed poor correlation
with the gold standard as classified by the senior author. All intraobserver agreements
demonstrated a moderate kappa agreement (K(w)=0.52) for the AO/ASIF classification
and fair for the Frykman (K(w)=0.26), Fernandez (K(w)=0.24) and Older (K(w)=0.27)
classifications. When the group was divided according to years of clinical experience
(<6 years; >or=6 years), there was poor correlation between experience and consistency
amongst all four classifications. In view of these findings, we do not recommend use
of these classifications for clinical application because of their questionable reproducibility
and reliability.