Evaluation of interobserver agreement in Albertoni's classification for mallet finger

Agreement study. Forty-three radiographs of patients with mallet finger were assessed by 19 responders (12 hand surgeons and seven residents). Injuries were classified by Albertoni's classification. For agreement comparison, lesions were grouped as: (A) tendon avulsion; (B) avulsion fracture; (C) fracture of the dorsal lip; and (D) physis injury-and subgroups (each group divided into two subgroups). Agreement was assessed by Fleiss's modification for kappa statistics.

Results:

Agreement was excellent for Group A (k = 0.95 (0.93-0.97)) and remained good when separated into A1 and A2. Group B was moderate (k = 0.42 (0.39-0.44)) and poor when separated into B1 and B2. In the Group C, agreement was good (k = 0.72 (0.70-0.74)), but when separated into C1 and C2, it became moderate. Group D was always poor (k = 0.16 (0.14-0.19)). The general agreement was moderate, with (k = 0.57 (0.56-0.58)).

Conclusion:

Albertoni's classification evaluated for interobserver agreement is considered a reproducible classification by the method used in the research.

Keywords:
Tendon injuries; Finger injuries; Reproducibility of results; Classification; Rupture; Acquired hand deformities

k-Value	Strength of agreement
<0.00	No agreement
0.01–0.20	Very poor
0.21–0.40	Poor
0.41–0.60	Moderate
0.61–0.80	Good
0.81–1.00	Excellent

Radiographs	Options according to Albertoni classification
	A1	A2	B1	B2	C1	C2	D
1	19	0	0	0	0	0	0
2	0	19	0	0	0	0	0
3	0	0	1	0	12	6	0
4	12	1	0	0	0	0	6
5	0	19	0	0	0	0	0
6	5	14	0	0	0	0	0
7	18	1	0	0	0	0	0
8	0	19	0	0	0	0	0
9	6	13	0	0	0	0	0
10	0	19	0	0	0	0	0
11	0	0	0	0	13	6	0
12	0	0	7	0	8	4	0
13	0	0	14	1	4	0	0
14	0	0	12	1	6	0	0
15	0	0	0	0	18	1	0
16	0	19	0	0	0	0	0
17	19	0	0	0	0	0	0
18	0	0	3	1	7	8	0
19	0	0	4	10	1	4	0
20	0	0	2	0	9	8	0
21	0	0	0	1	11	7	0
22	0	0	1	1	1	16	0
23	0	0	1	1	9	8	0
24	0	0	0	0	8	11	0
25	0	0	16	0	3	0	0
26	0	0	0	0	18	1	0
27	0	0	0	0	11	8	0
28	0	0	1	0	18	0	0
29	0	0	0	0	18	1	0
30	0	0	2	0	17	0	0
31	0	0	0	0	18	1	0
32	0	0	3	0	2	14	0
33	3	16	0	0	0	0	0
34	0	0	7	0	10	2	0
35	0	0	9	0	7	0	3
36	0	0	8	0	8	0	3
37	0	0	0	0	17	2	0
38	12	0	7	0	0	0	0
39	0	0	1	1	1	16	0
40	19	0	0	0	0	0	0
41	0	0	2	0	14	3	0
42	14	5	0	0	0	0	0
43	0	0	1	0	1	14	3

The Albertoni classification
Observer	A1		A2		B1		B2		C1		C2		D
	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Surgeons
1	6	14.0	8	18.6	1	2.3	0	0.0	12	27.9	16	37.2	0	0.0
2	7	16.3	7	16.3	1	2.3	0	0.0	19	44.2	7	16.3	2	4.7
3	8	18.6	6	14.0	5	11.6	0	0.0	15	34.9	9	20.9	0	0.0
4	5	11.6	9	20.9	6	14.0	1	2.3	14	32.6	8	18.6	0	0.0
5	9	20.9	6	14.0	1	2.3	0	0.0	11	25.6	16	37.2	0	0.0
6	8	18.6	6	14.0	10	23.3	2	4.7	14	32.6	2	4.7	1	2.3
7	8	18.6	6	14.0	8	18.6	0	0.0	16	37.2	5	11.6	0	0.0
8	6	14.0	8	18.6	7	16.3	1	2.3	12	27.9	8	18.6	1	2.3
9	7	16.3	7	16.3	2	4.7	0	0.0	22	51.2	5	11.6	0	0.0
10	5	11.6	10	23.3	8	18.6	5	11.6	11	25.6	4	9.3	0	0.0
11	5	11.6	9	20.9	7	16.3	1	2.3	12	27.9	8	18.6	1	2.3
12	9	20.9	6	14.0	3	7.0	3	7.0	18	41.9	4	9.3	0	0.0
Total	83	16.1	88	17.1	59	11.4	13	2.5	176	34.1	92	17.8	5	1.0

Residents
13	7	16.3	7	16.3	12	27.9	0	0.0	11	25.6	5	11.6	1	2.3
14	7	16.3	8	18.6	2	4.7	0	0.0	13	30.2	11	25.6	2	4.7
15	6	14.0	9	20.9	4	9.3	1	2.3	11	25.6	12	27.9	0	0.0
16	6	14.0	9	20.9	7	16.3	1	2.3	15	34.9	4	9.3	1	2.3
17	5	11.6	8	18.6	5	11.6	1	2.3	12	27.9	10	23.3	2	4.7
18	6	14.0	8	18.6	7	16.3	0	0.0	17	39.5	3	7.0	2	4.7
19	7	16.3	8	18.6	6	14.0	1	2.3	15	34.9	4	9.3	2	4.7
Total	44	14.6	57	18.9	43	14.4	4	1.3	94	31.2	49	16.3	10	3.3
Grand total	127	15.5	145	17.7	102	12.6	17	2.1	270	33.0	141	17.3	15	1.8

Grouped Albertoni classification
	A		B		C		D
	n	%	n	%	n	%	n	%
Surgeons
	14	32.6	1	2.3	28	65.1	–	–
	14	32.6	1	2.3	26	60.5	2	4.7
	14	32.6	5	11.6	24	55.8	–	–
	14	32.6	7	16.3	22	51.2	–	–
	15	34.9	1	2.3	27	62.8	–	–
	14	32.6	12	27.9	16	37.2	1	2.3
	14	32.6	8	18.6	21	48.8	–	–
	14	32.6	8	18.6	20	46.5	1	2.3
	14	32.6	2	4.7	27	62.8	–	–
	15	34.9	13	30.2	15	34.9	–	–
	14	32.6	8	18.6	20	46.5	1	2.3
	15	34.9	6	14.0	22	51.2	–	–
Total	171	33.1	72	14.0	268	51.9%	5	1.0

Residents
	14	32.6	12	27.9	16	37.2	1	2.3
	15	34.9	2	4.7	24	55.8	2	4.7
	15	34.9	5	11.6	23	53.5	–	–
	15	34.9	8	18.6	19	44.2	1	2.3
	13	30.2	6	14.0	22	51.2	2	4.7
	14	32.6	7	16.3	20	46.5	2	4.7
	15	34.9	7	16.3	19	44.2	2	4.7
Total	101	33.6	47	15.6	143	47.5	10	3.3
Grand total	272	33.3	119	14.6	411	50.3	15	1.8

Classification	k (95% confidence interval)	Classification	k (95% confidence interval)
Surgeon
A	0.95 (0.91–0.99)	A1	0.75 (0.71–0.78)
		A2	0.84 (0.80–0.87)
B	0.34 (0.31–0.38)	B1	0.34 (0.30–0.37)
		B2	0.19 (0.15–0.23)
C	0.71 (0.67–0.75)	C1	0.51 (0.48–0.55)
		C2	0.44 (0.41–0.48)
D	0.10 (0.06–0.14)	D	0.10 (0.06–0.14)
General	0.72 (0.69–0.74)		0.56 (0.54–0.58)

Resident
A	0.96 (0.89–1.00)	A1	0.82 (0.76–0.89)
		A2	0.90 (0.83–0.96)
B	0.55 (0.48–0.61)	B1	0.46 (0.39–0.52)
		B2	0.49 (0.43–0.56)
C	0.77 (0.70–0.83)	C1	0.49 (0.43–0.56)
		C2	0.37 (0.30–0.43)
D	0.24 (0.18–0.31)	D	0.24 (0.18–0.31)
General	0.76 (0.72–0.81)		0.59 (0.55–0.62)

Surgeon + Resident
A	0.95 (0.93–0.97)	A1	0.77 (0.74–0.79)
		A2	0.86 (0.84–0.88)
B	0.42 (0.39–0.44)	B1	0.38 (0.36–0.40)
		B2	0.28 (0.26–0.30)
C	0.72 (0.70–0.74)	C1	0.52 (0.50–0.54)
		C2	0.42 (0.39–0.44)
D	0.16 (0.14–0.19)	D	0.16 (0.14–0.19)
General	0.73 (0.71–0.74)		0.57 (0.56–0.58)

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: vinicius.asa@hotmail.com(V.A. Almeida).

Radiographs	Options according to Albertoni classification
	A1	A2	B1	B2	C1	C2	D
1	19	0	0	0	0	0	0
2	0	19	0	0	0	0	0
3	0	0	1	0	12	6	0
4	12	1	0	0	0	0	6
5	0	19	0	0	0	0	0
6	5	14	0	0	0	0	0
7	18	1	0	0	0	0	0
8	0	19	0	0	0	0	0
9	6	13	0	0	0	0	0
10	0	19	0	0	0	0	0
11	0	0	0	0	13	6	0
12	0	0	7	0	8	4	0
13	0	0	14	1	4	0	0
14	0	0	12	1	6	0	0
15	0	0	0	0	18	1	0
16	0	19	0	0	0	0	0
17	19	0	0	0	0	0	0
18	0	0	3	1	7	8	0
19	0	0	4	10	1	4	0
20	0	0	2	0	9	8	0
21	0	0	0	1	11	7	0
22	0	0	1	1	1	16	0
23	0	0	1	1	9	8	0
24	0	0	0	0	8	11	0
25	0	0	16	0	3	0	0
26	0	0	0	0	18	1	0
27	0	0	0	0	11	8	0
28	0	0	1	0	18	0	0
29	0	0	0	0	18	1	0
30	0	0	2	0	17	0	0
31	0	0	0	0	18	1	0
32	0	0	3	0	2	14	0
33	3	16	0	0	0	0	0
34	0	0	7	0	10	2	0
35	0	0	9	0	7	0	3
36	0	0	8	0	8	0	3
37	0	0	0	0	17	2	0
38	12	0	7	0	0	0	0
39	0	0	1	1	1	16	0
40	19	0	0	0	0	0	0
41	0	0	2	0	14	3	0
42	14	5	0	0	0	0	0
43	0	0	1	0	1	14	3

Radiographs	Options according to Albertoni classification
	A1	A2	B1	B2	C1	C2	D
1	19	0	0	0	0	0	0
2	0	19	0	0	0	0	0
3	0	0	1	0	12	6	0
4	12	1	0	0	0	0	6
5	0	19	0	0	0	0	0
6	5	14	0	0	0	0	0
7	18	1	0	0	0	0	0
8	0	19	0	0	0	0	0
9	6	13	0	0	0	0	0
10	0	19	0	0	0	0	0
11	0	0	0	0	13	6	0
12	0	0	7	0	8	4	0
13	0	0	14	1	4	0	0
14	0	0	12	1	6	0	0
15	0	0	0	0	18	1	0
16	0	19	0	0	0	0	0
17	19	0	0	0	0	0	0
18	0	0	3	1	7	8	0
19	0	0	4	10	1	4	0
20	0	0	2	0	9	8	0
21	0	0	0	1	11	7	0
22	0	0	1	1	1	16	0
23	0	0	1	1	9	8	0
24	0	0	0	0	8	11	0
25	0	0	16	0	3	0	0
26	0	0	0	0	18	1	0
27	0	0	0	0	11	8	0
28	0	0	1	0	18	0	0
29	0	0	0	0	18	1	0
30	0	0	2	0	17	0	0
31	0	0	0	0	18	1	0
32	0	0	3	0	2	14	0
33	3	16	0	0	0	0	0
34	0	0	7	0	10	2	0
35	0	0	9	0	7	0	3
36	0	0	8	0	8	0	3
37	0	0	0	0	17	2	0
38	12	0	7	0	0	0	0
39	0	0	1	1	1	16	0
40	19	0	0	0	0	0	0
41	0	0	2	0	14	3	0
42	14	5	0	0	0	0	0
43	0	0	1	0	1	14	3

Brasil

Brasil

Evaluation of interobserver agreement in Albertoni's classification for mallet finger☆ ☆ Study conducted at Disciplina de Cirurgia da Mão e Membro Superior, Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

Evaluation of interobserver agreement in Albertoni's classification for mallet finger^☆ ☆ Study conducted at Disciplina de Cirurgia da Mão e Membro Superior, Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Radiographs	Options according to Albertoni classification
	A1	A2	B1	B2	C1	C2	D
1	19	0	0	0	0	0	0
2	0	19	0	0	0	0	0
3	0	0	1	0	12	6	0
4	12	1	0	0	0	0	6
5	0	19	0	0	0	0	0
6	5	14	0	0	0	0	0
7	18	1	0	0	0	0	0
8	0	19	0	0	0	0	0
9	6	13	0	0	0	0	0
10	0	19	0	0	0	0	0
11	0	0	0	0	13	6	0
12	0	0	7	0	8	4	0
13	0	0	14	1	4	0	0
14	0	0	12	1	6	0	0
15	0	0	0	0	18	1	0
16	0	19	0	0	0	0	0
17	19	0	0	0	0	0	0
18	0	0	3	1	7	8	0
19	0	0	4	10	1	4	0
20	0	0	2	0	9	8	0
21	0	0	0	1	11	7	0
22	0	0	1	1	1	16	0
23	0	0	1	1	9	8	0
24	0	0	0	0	8	11	0
25	0	0	16	0	3	0	0
26	0	0	0	0	18	1	0
27	0	0	0	0	11	8	0
28	0	0	1	0	18	0	0
29	0	0	0	0	18	1	0
30	0	0	2	0	17	0	0
31	0	0	0	0	18	1	0
32	0	0	3	0	2	14	0
33	3	16	0	0	0	0	0
34	0	0	7	0	10	2	0
35	0	0	9	0	7	0	3
36	0	0	8	0	8	0	3
37	0	0	0	0	17	2	0
38	12	0	7	0	0	0	0
39	0	0	1	1	1	16	0
40	19	0	0	0	0	0	0
41	0	0	2	0	14	3	0
42	14	5	0	0	0	0	0
43	0	0	1	0	1	14	3