The Journal of Bone and Joint Surgery, Vol 76, Issue 8 1162-1166, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Interobserver agreement in the classification of open fractures of the tibia. The results of a survey of two hundred and forty-five orthopaedic surgeons
RJ Brumback and AL Jones
Orthopaedic Trauma Association, Baltimore, Maryland.
The system of Gustilo and Anderson for the classification of open fractures
is commonly used as a basis for treatment decisions and for comparison of
the published results of treatment. The reliability of this classification
system was tested on the basis of the responses of 245 orthopaedic surgeons
to a survey. The respondents were asked to provide data about their age,
type of practice, and type of training; the number of open fractures of the
tibia that they treated each year; and their use of the Gustilo-Anderson
classification system. They were also asked to classify twelve open
fractures of the tibia on the basis of a series of videotaped case
presentations. Each case presentation on the color videotape included
demographic data on the patient, a history of the injury, the results of
the physical examination, the appearance and dimensions of the open wound
before the operation, preoperative radiographs, and selected portions of
the operative debridement with narration. The level of agreement for the
classification of each fracture was determined according to the largest
percentage of observers who chose a single classification type. The average
agreement among the observers for all twelve fractures was 60 percent. The
over-all agreement for each fracture ranged from 42 to 94 percent. The
average agreement in the subgroup of surgeons who were considered to have
the least experience (residents and fellows) was 59 per cent (range, 33 to
94 percent).(ABSTRACT TRUNCATED AT 250 WORDS)
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