![]() However, the use of a classification system with poor reproducibility will generate confusing results when patient outcomes are assessed, and that seems to be exactly what has occurred in studies that used the Mayo classification. Although one might expect interrater reliability to be improved with a simpler classification, in this instance, that did not occur.ĭespite concerns about its reliability, the Mayo classification is frequently used in outcome-based studies. The reproducibility of the Mayo classification may be worse than other classification systems for olecranon fractures. Despite the relative improvement in reproducibility shown in this study, the interrater reliability remained poor.īoth existing studies showed that the Mayo classification has poor reproducibility indicating low reliability. found the Mayo classification to have the highest intrarater agreement (κ = 0.64) and second highest interrater agreement (κ = 0.32) compared with the other classification systems of olecranon fractures. showed the worst interrater agreement for the Mayo classification with a κ coefficient of 0.19 compared with κ = 0.67 for the Colton classification. When comparing between classifications, these studies showed conflicting results when the Mayo classification was compared with the Colton, Schatzker, and AO classifications. These studies showed an interobserver agreement of the Mayo classification system of κ = 0.19 and κ = 0.32, which represent poor reliability, with interobserver agreement being only marginally greater than chance alone.īy contrast, there was moderate intraobserver reliability in one of these two studies, at κ = 0.64, whereas the other reported poor intraobserver agreement for specialists (κ = 0.18) and moderate among nonspecialists (κ = 0.51). Interobserver agreement refers to the agreement between different observers and intraobserver agreement is the measure of repeated agreement of the same observer at different time points. Kappa values of ≤ 0.5 are considered poor, 0.51 to 0.74 good, and ≥ 0.75 an excellent level of agreement. Kappa values range from 0 to 1 with a value of 0 denoting agreement at the level of random chance and 1 representing complete agreement. This coefficient assesses the level of agreement between observers that is beyond agreement that would occur by chance alone. The referenced studies assessed agreement using a κ coefficient rather than observed agreement. ![]() Two studies of which we are aware have assessed the reproducibility of the Mayo classification in comparison to the Colton, Schatzker, and AO classifications. In such injuries, rigid fixation of the olecranon is imperative to restore stability of the ulnohumeral joint. In a Type III injury, the ulnohumeral joint is dislocated indicating that the collateral ligaments are torn. An important aspect of this classification is the differentiation between a Type II and Type III injury. The associated injuries and instability may result in worse functional outcomes than Types I and II injuries. In addition to the substantial displacement and comminution seen with Type III injuries, they often have associated injuries including radial head fractures, coronoid fractures, and complex instability. A good prognosis was expected with Type II injuries as a result of the maintained ligamentous structures and prior studies, which had shown 97% good to excellent functional outcomes in patients treated with tension band wiring for isolated, displaced olecranon fractures. In the initial description of this classification, Types I, II, and III prognoses were excellent, good, and guarded, respectively. Philadelphia, PA, USA: Elsevier Inc 2017. Reproduced with permission from Morrey BF, Sanchez-Sotelo J, Morrey ME. In the Mayo classification of olecranon fractures, each type is further subclassified to indicate noncomminuted ( A) and comminuted ( B) fractures.
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