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abstract
Full article available online at OrthoSuperSite.com/view.asp?rID=40074
Classifi cation systems for pelvic ring injuries have been developed to assist in understanding the anatomy of the injury, predicting prognosis, and helping defi ne treatment. Despite the frequent clinical use of the Young-Burgess and Tile classifi cation systems, to our knowledge little work has been conducted to validate either system. We assessed the degree of inter- and intraobserver variability when using both the Young-Burgess and Tile classifi cation systems and thereby assessed their validity for clinical use.
Eighty-nine isolated pelvic ring disruptions were selected. Sets of injury images were randomly ordered and distributed to 5 orthopedic trauma surgeons blinded to the patients' names, attending surgeons, dates of injury, and eventual treatments. The surgeons were asked to independently classify each pelvic ring disruption based on the Young- Burgess and Tile classifi cations. Eight weeks later, the same images were randomly ordered and redistributed to the same 5 surgeons, who were again asked to classify the pelvic injuries. A kappa analysis was conducted to analyze agreement among surgeons. A moderate degree of agreement was shown among orthopedic trauma surgeons when using both the Young-Burgess and Tile classifi cation systems. Intraobserver agreement was found to be substantial for the Young-Burgess classifi cation and moderate for the Tile classifi cation. The degree of inter- and intraobserver variability may limit the usefulness of the 2 classifi cation systems, both clinically and for research purposes.
Disruptions of the pelvic ring remain clinically challenging. Injuries to the pelvis not only impact long-term patient function but can also signify an immediate threat to the patient's life.1 Numerous treatment options, both surgical and nonsurgical, are available. The specifi cs of the injury pattern help determine the appropriate treatment plan. To assist in understanding the anatomy of the injury and thereby the decision-making process, several pelvic ring disruption classifi cation systems have been proposed.
In the 1980s, studies described a general classifi cation based on the vector of initiating force.2-4 They described 3 basic patterns according to the deforming forces as follows: vertical shear, anterior-posterior compression, and lateral compression.
Tile5 further proposed a classifi cation system using radiographic criteria to decide which injuries are mechanically stable and which are not, and therefore which pelvic injuries require...