Evaluation of the Interobserver Agreement of the Fraser and Blake & McBryde Classifications for Floating Knee^[*]

Abstract

Objective To evaluate the interobserver agreement of two classifications for floating knee: Fraser and Blake & McBryde.

Method Thirty-two observers, subdivided according to the degree of titration (26 resident physicians and 6 orthopedic physicians specialized in orthopedic trauma), classified 15 fractures of the ipsilateral femur and tibia. Interobserver agreement was evaluated by using the Kappa coefficient.

Result When evaluating the agreement between the 9 R1, a Kappa index of 0.58 was obtained for the Fraser classification and of 0.46 for the Blake & McBryde classification. Among the 7 R2, a rate of 0.59 was obtained for the Fraser rating and 0.51 for the Blake & McBryde rating. Among the 10 R3, the agreement index was higher for both classifications: 0.72 for the Fraser and 0.71 for the Blake & McBryde classification. Considering the 3 groups (R1, R2, R3) as one large group, the general Kappa index was calculated, which resulted in 0.63 for the Fraser classification and 0.56 for the Blake & McBryde classification. In the group of trauma and orthopedic knee specialists, in turn, an agreement of 0.597 was obtained for the Blake and McBryde classification and of 0.843 for the Fraser classification.

Conclusion Comparatively, the two classifications presented a weak to moderate degree of agreement. Fraser classification had better agreement in both groups. The agreement was higher when evaluating orthopedic trauma physicians.

Keywords

tibia fractures/classification - validation studies - evaluation

^* Work developed in the Department of Orthopedics and Traumatology, Instituto Doutor José Frota, Fortaleza, Ceará, Brazil.

Financial Support

There was no financial support from public, commercial, or non-profit sources.

Publication History

Received: 08 December 2019

Accepted: 17 March 2020

Article published online:
02 October 2020

• Referências

• 1 Muñoz Vives J, Bel JC, Capel Agundez A. et al. The floating knee: a review on ipsilateral femoral and tibial fractures. EFORT Open Rev 2017; 1 (11) 375-382
• 2 Bertrand ML, Andrés-Cano P. Management of the Floating Knee in Polytrauma Patients. Open Orthop J 2015; 9: 347-355
• 3 Lugones A, Mangupli M, Galera H, DÃaz Gallardo P, Pioli I. et al. Tratamiento, lesiones asociadas y complicaciones en las fracturas homolaterales del fémur y la tibia: “Rodilla flotante”. Rev Asoc Argentina Ortop y Traumatol 2010; 75 (04) 370-375
• 4 Feron JM, Bonnevialle P, Pietu G, Jacquot FI. Traumatic Floating Knee: A Review of a Multi-Centric Series of 172 Cases in Adult. Open Orthop J 2015; (Suppl. 01) (M11): 356-360
• 5 Rüedi TP, Buckley RE, Moran CG. Princípios AO do Tratamento de Fraturas. 2a ed. Porto Alegre: Art Med; 2009
• 6 Fraser RD, Hunter GA, Waddell JP. Ipsilateral fracture of the femur and tibia. J Bone Joint Surg Br 1978; 60-B [phone]
• 7 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (01) 159-174
• 8 Schwartsmann CR, Boschin LC, Moschen GM. et al. Classificação das fraturas trocantéricas: avaliação da reprodutibilidade da classificação AO. Rev Bras Ortop 2006; 41 (07) 264-267
• 9 Albuquerque RP, Giordano V, Pallottino A. et al. Analise da reprodutibilidade das classificações das fraturas do platô tibial. Rev Bras Ortop 2009; 44 (03) 225-229
• 10 Thomsen NO, Overgaard S, Olsen LH, Hansen H, Nielsen ST. Observer variation in the radiographic classification of ankle fractures. J Bone Joint Surg Br 1991; 73 (04) 676-678
• 11 Sidor ML, Zuckerman JD, Lyon T, Koval K, Cuomo F, Schoenberg N. The Neer classification system for proximal humeral fractures. An assessment of interobserver reliability and intraobserver reproducibility. J Bone Joint Surg Am 1993; 75 (12) 1745-1750
• 12 Gusmo PD, Mothes FC, Rubin LA, Gonçalves RZ, Telöken MA, Schwartsmann CR. Avaliação da reprodutibilidade da classificação de Garden para fraturas do colo femural. Rev Bras Ortop 2002; 37 (09) 381-386
• 13 Demirtas A, Azboy I, Alemdar C. et al. Functional outcomes and quality of life in adult ipsilateral femur and tibia fractures. J Orthop Translat 2018; 16: 53-61
• 14 Vaidyanathan S, Panchanathan Ganesan J, Moongilpatti Sengodan M. Floating knee injury associated with patellar tendon rupture: a case report and review of literature. Case Rep Orthop 2012 2012; 913230
• 15 Paul GR, Sawka MW, Whitelaw GP. Fractures of the ipsilateral femur and tibia: emphasis on intra-articular and soft tissue injury. J Orthop Trauma 1990; 4 (03) 309-314
• 16 Adamson GJ, Wiss DA, Lowery GL, Peters CL. Type II floating knee: ipsilateral femoral and tibial fractures with intraarticular extension into the knee joint. J Orthop Trauma 1992; 6 (03) 333-339
• 17 Hung SH, Lu YM, Huang HT. et al. Surgical treatment of type II floating knee: comparisons of the results of type IIA and type IIB floating knee. Knee Surg Sports Traumatol Arthrosc 2007; 15 (05) 578-586
• 18 Hegazy AM. Surgical management of ipsilateral fracture of the femur and tibia in adults (the floating knee): postoperative clinical, radiological, and functional outcomes. Clin Orthop Surg 2011; 3 (02) 133-139