Classification systems for distal radius fractures

Figures & data

Table 3. Overview of included classification systems

Classification, types (n), and description of types
Frykman (1967), 8 (I–VIII)
I	Extra-articular
II	Extra-articular with ulnar fracture
III	Intra-articular into radiocarpal joint
IV	Intra-articular into radiocarpal joint with ulnar fracture
V	Intra-articular into radioulnar joint
VI	Intra-articular into radioulnar joint with ulnar fracture
VII	Intra-articular into radiocarpal + radioulnar joints
VIII	Intra-articular into radiocarpal + radioulnar joints with ulnar fracture
Fernández (2001), 5 types, based on trauma mechanism
Type 1	Bending fracture of metaphysis
Type 2	Shearing fracture of joint surface
Type 3	Compression fracture of joint surface
Type 4	Avulsion fractures or radiocarpal fracture-dislocation
Type 5	Combined fractures associated with high high-velocity injuries
Universal (1993), 4 types, subdivision in 2 x 3 groups
Type 1	Extra-articular fracture, without deviation
Type 2	Extra-articular fracture, with deviation
2A	Reducible and stable
2B	Reducible and unstable
2C	Irreducible
Type 3	Intra-articular fracture, without deviation
Type 4	Intra-articular fracture, with deviation
4A	Reducible and stable
4B	Reducible and unstable
4C	Irreducible
AO/ASIF (2007), 3 types, 9 groups
A	Extra-articular fractures
A1	Ulnar fracture, radius intact
A2	Radius fracture, simple and impacted
A3	Radius fracture, multifragmentary
B	Partial articular fractures
B1	Radius fracture, sagittal
B2	Radius fracture, frontal, dorsal rim
B3	Radius fracture, frontal, volar rim
C	Complete articular fractures
C1	Articular simple + metaphyseal simple
C2	Articular simple, metaphyseal multifragmentary
C3	Articular multifragmentary

Flow chart of patients in the study.

Table 4. Intraobserver reliability

	CR		CR + CT scan
Classification	ICC	Agreement	ICC	Agreement	p
Frykman	0.57 (0.34–0.77)	Fair	0.51 (0.33–0.80)	Fair	0.6
Fernandez	0.53 (0.32–0.62)	Fair	0.66 (0.53–0.90)	Good	0.1
Universal	0.57 (0.43–0.71)	Fair	0.64 (0.50–0.78)	Good	0.5
AO groups	0.59 (0.51–0.66)	Fair	0.71 (0.56–0.91)	Good	0.3

CR: Conventional radiographs

ICC: Mean intra-class correlation coefficient of the Intraobserver ­reliability with the range of the 4 observers in parentheses

Table 5. Interobserver reliability

	CR		CR + CT scan
Classification	ICC	Agreement	ICC	Agreement	p
Frykman	0.45 (0.31–0.60)	Fair	0.28 (0.14–0.44)	Poor	0.03
Fernandez	0.38 (0.21–0.55)	Poor	0.44 (0.30–0.59)	Fair	0.4
Universal	0.32 (0.18–0.48)	Poor	0.43 (0.20–0.51)	Fair	0.01
AO groups	0.46 (0.31–0.60)	Fair	0.40 (0.26–0.53)	Fair	0.4

CR: Conventional radiographs

ICC: Mean intraclass coefficient of the interobserver reliability with 95% CI in parentheses.

Table 6. Distribution of fracture types in round 1 (CR: conventional radiography) and round 3 (CR + CT: CR + additional CT scan) of all 4 observers given in percentages

Frykman	I	II	III	IV	V	VI	VII	VIII
CR	9	5	20	25	3	1	18	19^a
CR + CT	5	2	18	16	3	0	24	31^a
Fernandez	1	2	3	4	5
CR	18^a	11^a	50	1	20
CR + CT	7^a	21^a	59	0	13
Universal	1	2A	2B	2C	3	4A	4B	4C
CR	2	8	4	0	4	25	39	17
CR + CT	1	5	1	0	9	27	32	24
AO groups	A2	A3	B1	B2	B3	C1	C2	C3
CR	12^a	4	1	3	12	31^a	30	6^a
CR + CT	2^a	5	3	5	12	19^a	32	22^a

a Significant changes in fracture distribution in that category.

Table 7. Percentage of changes in classification after adding a CT scan (round 1 versus 3)

Frykman	I + II	III + IV	V + VI	VII + VIII
	69	48	78	0
Fernandez	1	2	3	4	5
	69	41	7	n/a	0
Universal	1	2A	2B	3	4A	4B	4C
	60	71	75	25	29	23	0
AO groups	A2	A3	C1	C2	C3
	88	89	51	25	0

Frykman: The fracture types with and without an ulnar fracture are added together.

Fernandez: type 4 and Universal type 2c were not taken into account, because these were not classified.

Frykman G. Fracture of the distal radius including sequelae: Shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand 1967; 108 (Suppl): 108–53.

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