Observer variation in ankle fracture classification amongst orthopaedic surgeons in Brunei Darussalam Mohammad Abdul Hafidz YAKOB 1 , SA Jamaludin 2 , Ketan PANDE 1 1 Department of Orthopaedics, and 2 Department of General Surgery, RIPAS Hospital, Brunei Darussalam ABSTRACT Introduction: Classification systems can be used in the treatment of fractures to grade severity of injury, plan treatment, predict and compare results. Different classification systems are available for ankle fractures. These systems are subject to observer variation and have been studied with varying results. The aim of this study was to assess the observer variation of the Lauge-Hansen and AO Weber classification of ankle fractures and to assess the agreement regarding the use of a syndesmotic screw in treatment of ankle fractures. Materials and Methods: Antero-posterior and lateral radiographs of patients who have undergone surgery for ankle fractures were collected (n=30). Eight orthopaedic sur- geons of varying experience graded the radiographs independently and their inter- and intra-observer agreement was assessed using the kappa statistic. Two assessment sessions were conducted three weeks apart and each session was preceded by a presentation of the fracture classifications studied. Results: The results were expressed as mean kappa value. For the Lauge-Hansen classification the inter-observer value was 0.58 and intra-observer value was 0.64 and for AO Weber the values were 0.65 and 0.77 respectively. For the use of syndesmotic screw the values were 0.34 and 0.59 respec- tively. Level of experience was noted to have no effect on the intra-observer variation. Conclusion: AO Weber classification had better observer agreement compared to Lauge-Hansen classification and should be preferred. The decision for using a syndesmotic screw should not be based on radiological findings alone. Keywords: Observer variation, ankle fracture, AO Weber classification, Lauge-Hansen classification, Kappa statistic Original Article Correspondence author: Mohammad Abdul Hafidz HJ YAKOB Department of Orthopaedics, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam. Tel: +673 7160177 E mail: fizzy_83@hotmail.com Brunei Int Med J. 2014; 10 (6): 314-319 INTRODUCTION In the orthopaedics specialty, classification systems are used to assess various injuries. These help in grading the severity of an inju- ry, plan appropriate treatment and often can INTRODUCTION be used to predict outcome. Classification systems can also be used to quantify results, allowing us to compare practise between treatment centres. With ankle fractures, sev- eral classification systems are available. The decision for surgery is often based on radio- graphs of these injuries. With regards to sta- bility of the ankle joint one is also able to as- sess the integrity of the syndesmosis and