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Background: The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation.

Objetive: The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification.

Methods: This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories.

Results: Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86).

Conclusions:Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies.

Level of Evidence: Level IV, Case Series

Carlos Oliver Valderrama-Molina, Hospital Pablo Tobón Uribe Universidad de Antioquia

Orthopaedic Surgery Section

Chief of Section

Mauricio Estrada-Castrillón, Hospital Pablo Tobón Uribe

Radiologist, Fellowship in Musculoskeletal Radiology

Hospital Pablo Tobón Uribe (Radiologist)

Jorge Andres Hincapie, Universidad de Antioquia

Universidad de Antioquia, Medicine School, Rehabilitation in Health Group - Research Assistant

Luz Helena Lugo-Agudelo, Universidad de Antioquia

Clinical Epidemiologist, MSc

Universidad de Antioquia (Titular Professor Universidad de Antioquia)

Chief of Rehabilitation in Health Group, Universidad de Antioquia

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Received 2013-12-09
Accepted 2014-12-17
Published 2014-12-30