The interobserver and intraobserver reliability of the Fernandez classification of distal radius fracture

Background: With increasing knowledge concerning fractures of the distal radius, different classifications have been proposed. Reliability of most of these classifications has been assessed. The Fernandez classification has never been assessed for intraobserver and interobserver reliability, although this classification is commonly used. Methods: Five observers including one attending orthopaedic hand surgeon, one hand surgery fellow, two attending orthopaedic surgeons and one senior resident of orthopaedic surgery classified 42 standard anteroposterior and lateral radiographs of prereduction distal radius fractures. Four weeks later the radiographs were renumbered differently and reviewed and classified by the same observers. Reliability of classification was assessed by Kappa value. Results: The mean intraobserver Kappa value was 0.64 (0.53-0.73), indicating good or substantial reliability, while the mean interobserver reliability was 0.45(0.30- 0.71) representing moderate reliability. Conclusion: In contrast to previous classifications of distal radius fracture, which their intraobserver and interobserver reliabilities were poor or moderate in most studies, the Fernandez classification has good intraobserver reliability and moderate interobserver reliability, so it can be used by orthopaedic surgeons with more confidence.