Reproducibility of Bartonicek and Haraguchi classifications of the posterior malleolus fractures

Background Two of the most commonly used classifications for the posterior malleolus fracture are Haraguchi and Bartonicek. Both classifications are based on the morphology of the fracture. This study makes an inter- and intra-observer agreement analysis of the mentioned classifications. Methods 39 patients with ankle fractures who met inclusion criteria were selected. All the fractures were analyzed and classified twice by each of the 20 observers using Bartonicek and Haraguchi's classifications, with a window period of at least 30 days between the two rounds. Results Analysis was made by Kappa coefficient (kappa). The global intraobserver value was kappa = 0.627 in the Bartonicek classification and kappa = 0.644 in the Haraguchi one. The first round global interobserver kappa = 0.589 (0.574-0.604) on the Bartonicek classification and kappa = 0.534 (0.517-0.551) on the Haraguchi one. Second round coefficients were kappa = 0.601 (0.585-0.616) and kappa = 0.536 (0.519-0.554), respectively. The best agreement was when there was involvement of the posteromedial malleolar zone with kappa = 0.686 and kappa = 0.687 in Haraguchi II and kappa = 0.641 and kappa = 0.719 in Bartonicek III. No differences were observed in Kappa values when an experience-based analysis was made. Conclusion Bartonicek and Haraguchi classifications of the posterior malleolus fracture have both substantial intraobserver agreement but moderate to substantial agreement in interobserver analysis.