000			04893nam a22004217a 4500
008			220221s20222022 xxu||||| |||| 00| 0 eng d
024			_a00003086-990000000-00629 [pii]
024			_a10.1097/CORR.0000000000002131 [doi]
040			_aOvid MEDLINE(R)
099			_a35081080
245			_aWhat Is the Interrater and Intrarater Reliability of the Lawrence and Botte Classification System of Fifth Metatarsal Base Fractures?.
251			_aClinical Orthopaedics & Related Research. 2022 Jan 26
252			_aClin Orthop. 2022 Jan 26
253			_aClinical orthopaedics and related research
260			_c2022
260			_fFY2022
260			_p2022 Jan 26
265			_saheadofprint
266			_d2022-02-21
501			_aAvailable online from MWHC library: 1997 - present, Available in print through MWHC library: 1999 - 2003
520			_aBACKGROUND: Fractures of the proximal fifth metatarsal are common, and often they are classified using a three-part scale first proposed by Lawrence and Botte. A clear consensus on prognosis and treatment for these fractures is lacking, particularly for fractures in the middle classification, Zone 2; the reliability of the classification scheme itself may be partly at fault for this. The intra- and interrater reliability of the classification itself has never been established, and it remains unclear whether the three-part classification of fifth metatarsal fractures can be applied consistently enough to guide treatment.
520			_aCONCLUSION: The three-part Lawrence and Botte classification system demonstrated a concerningly low level of interrater reliability with an observed agreement of 77% compared with a chance agreement of 33%. The primary source of concern is the assessment of the interface between Zone 2 and Zone 3, which proved much less reliable than that between Zone 1 and Zone 2. This suggests that previous studies of isolated Zone 1 fractures likely contain a homogeneous fracture cohort, whereas studies of Zone 2 or Zone 3 fractures are likely to include a mixture of fracture types. In practice, the consensus treatment of fifth metatarsal fractures differs based on whether they represent a more proximal, avulsive injury or a more distal injury from indirect trauma. Our data suggest that the Lawrence and Botte classification should be abandoned. Further work should focus on developing a new classification scheme that demonstrates improved interobserver reliability and more directly corresponds to this treatment paradigm.
520			_aLEVEL OF EVIDENCE: Level III, diagnostic study. Copyright (c) 2022 by the Association of Bone and Joint Surgeons.
520			_aMETHODS: Thirty sets of initial presentation radiographs representing an equal number of fractures originally diagnosed by treating clinicians as Zone 1, Zone 2, and Zone 3 were evaluated and classified by three orthopaedic surgeons specializing in foot and ankle surgery and eight foot and ankle fellows to determine interrater reliability. Two weeks later, the same set of radiographs were reevaluated in random order to determine intrarater reliability. Kappa values for interrater and intrarater reliability were calculated. Additionally, the individual transitions between zones were separately analyzed by calculating kappa values for a hypothetical two-part classification based on each transition.
520			_aQUESTIONS/PURPOSES: When used by experienced orthopaedic surgeons, (1) What is the overall interrater reliability of the three-part Lawrence and Botte classification of fifth metatarsal base fractures? (2) What is the overall intrarater reliability of the three-part Lawrence and Botte classification of fifth metatarsal base fractures? (3) What are these same metrics for the individual transitions within the classification (Zone 1-2 and Zone 2-3)?
520			_aRESULTS: The three-part Lawrence and Botte classification of fifth metatarsal fractures demonstrated an overall interrater agreement of kappa = 0.66 (observed agreement 77% versus chance agreement 33%). Intrarater reliability for the 11 surgeons ranged from kappa = 0.60 to kappa = 0.90. A two-part scheme divided by the transition between Zone 1 and Zone 2 demonstrated an interrater agreement of kappa = 0.83, and a two-part scheme divided by the transition between Zone 2 and Zone 3 demonstrated a much lower interrater reliability of kappa = 0.66.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Union Memorial Hospital
656			_aOrthopaedic Surgery
657			_aJournal Article
700			_aAbousayed, Mostafa
700			_aGuyton, Gregory P
700			_aNoori, Naudereh
790			_aAbousayed M, Coleman MM, Guyton GP, Noori N
856			_uhttps://dx.doi.org/10.1097/CORR.0000000000002131 _zhttps://dx.doi.org/10.1097/CORR.0000000000002131
942			_cART _dArticle
999			_c816 _d816