Comparing clinician use of three ankle fracture classifications

Purpose: This study evaluated the accuracy and interrater reliability of US Army physician assistants (PAs) in identifying ankle fracture patterns using existing classifi cation schemes. Methods: Twenty-eight PAs reviewed criteria for stability, Danis-Weber, and Lauge-Hansen ankle fracture classifi cation systems. Participants reviewed 45 ankle radiographs and independently rated each radiograph using these classifi cation schemes. Results: Participants were able to successfully identify ankle fracture stability in 82.1% of cases (95% CI, 77.6, 86.6) with established criteria. Using the Danis-Weber classifi cation, accurate classifi cation was achieved in 77.8% of cases (95% CI, 72.8, 82.7). The Lauge-Hansen classifi cation system was least reliable, with accuracy of 54.5% (95% CI, 46, 63). Conclusion: Referring PAs can reliably discern unstable ankle fractures in more than 80% of cases. Lauge-Hansen classifi cation was signifi cantly less accurate than the Danis-Weber system or criteria for stability. Good communication between orthopedic surgeons and PAs and an emphasis on PA orthopedic education can improve patient care.