Abstract
Background: Several classification systems exist for sacral fractures; however, these systems are primarily descriptive, are not uniformly used, have not been validated, and have not been associated with a treatment algorithm or prognosis. The goal of the present study was to demonstrate the reliability of the AOSpine Sacral Classification System among a group of international spine and trauma surgeons. Methods: A total of 38 sacral fractures were reviewed independently by 18 surgeons selected from an expert panel of AOSpine and AOTrauma members. Each case was graded by each surgeon on 2 separate occasions, 4 weeks apart. Intrarater reproducibility and interrater agreement were analyzed with use of the kappa statistic (k) for fracture severity (i.e., A, B, and C) and fracture subtype (e.g., A1, A2, and A3). Results: Seventeen reviewers were included in the final analysis, and a total of 1,292 assessments were performed (646 assessments performed twice). Overall intrarater reproducibility was excellent (k = 0.83) for fracture severity and substantial (k = 0.71) for all fracture subtypes. When comparing fracture severity, overall interrater agreement was substantial (k = 0.75), with the highest agreement for type-A fractures (k = 0.95) and the lowest for type-C fractures (k = 0.70). Overall interrater agreement was moderate (k = 0.58) when comparing fracture subtype, with the highest agreement seen for A2 subtypes (k = 0.81) and the lowest for A1 subtypes (k = 0.20). Conclusions: To our knowledge, the present study is the first to describe the reliability of the AOSpine Sacral Classification System among a worldwide group of expert spine and trauma surgeons, with substantial to excellent intrarater reproducibility and moderate to substantial interrater agreement for the majority of fracture subtypes. These results suggest that this classification system can be reliably applied to sacral injuries, providing an important step toward standardization of treatment.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1454-1463 |
| Number of pages | 10 |
| Journal | Journal of Bone and Joint Surgery |
| Volume | 102 |
| Issue number | 16 |
| DOIs | |
| State | Published - Aug 19 2020 |
Funding
Disclosure: This study was organized and funded by AOSpine through the AOSpine Knowledge Forum Trauma, a focused group of international trauma experts in the field of orthopaedic traumatology and spine. AOSpine is a clinical division of the AO Foundation, which is an independent medically guided not-for-profit organization. Study support was provided directly through the AOSpine Research Department. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work ( http://links.lww.com/JBJS/F857 ).
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine