ANKLE FRACTURE CLASSIFICATION - A COMPARISON OF RELIABILITY OF 3 X-RAY VIEWS VERSUS 2

Our hypothesis was that malleolar ankle fractures could be classified with two radiographic views as reliably as with three views. Four diff erent observers independently evaluated 99 sets of ankle radiographs. The examiners classified the ankle fractures by using both the Lauge-H ansen and Danis-Weber systems. The interobserver and intraobserver var iations were analyzed by kappa statistics. With regard to intraexamine r reliability, the examiners demonstrated excellent accord in classify ing the fractures in the Danis-Weber system with either three views or two views. The kappa values were comparable. In the Lauge-Hansen syst em, three examiners demonstrated excellent accord and one examiner dem onstrated good accord in classifying the fractures. Similar kappa valu es were generated when examiners classified fractures with either thre e views or two views. With regard to interexaminer reliability, goad t o excellent accord was demonstrated overall among the four examiners w hen they used the Danis-Weber system with either three views or two vi ews. The examiners were in good agreement when they used the Lauge-Han sen system. Similar kappa values were generated whether the examiners used three views or two views. Three radiographic views are usually or dered for evaluation of an acute ankle injury. Previous studies have s hown that only two views are needed for diagnosis of a malleolar ankle fracture. This study demonstrates that maleolar ankle fractures can b e classified with two views, lateral or mortise, with a reliability as good as that achieved with three views. The best agreement is achieve d with lateral and mortise views.