Anatomical Versus Mechanism of Injury Classification Systems in Children's Ankle Fracture / 대한정형외과학회잡지

ABSTRACT

We evaluated the two classification systems of children's ankle fractures, the anatomical (Salter-Harris) and the mechanism of injury (Dias-Tachdjian) classifications, in terms of their usefulness and inter-observer variations. An ideal or useful classification system should comprise any possible types of injury, be easily remembered, and have little inter-observer variations. Five observers were asked to classify 57 physeal fractures of the ankle according to each classification systems. Fifty-four (94%) fractures were classifiable with Salter-Harris anatomical classification system. If we adopt the recently developed Peterson's anatomical classification system, the other three fractures could also be classified. In contrast, the mechanism of injury classification system of Dias and Tachdjian could be applied to 44 (77%) fractures. Though the mechanism of injury classification system was more cumbersome to understand, each observer successfully memorized both classification systems. For observer variations, calculated by kappa statistics, there was an acceptable level of agreement for overall classification by both systems. The results indicate that both classification systems of children's ankle fracture have reproducibility within an acceptable range of inter-observer variation. The Dias-Tachdjian's system needed to be upgraded to a more comprehensive one to include some variant types of ankle injuries.