Study: Masada classification is not the most reliable way to classify forearm deformities
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Compared with the Masada classification, the Jo and Gottschalk classifications offered better reliability for describing lesion characteristics of hereditary multiple osteochondromas in pediatric patients, according to a speaker.
“The classification most commonly used [for classifying hereditary multiple osteochondromas (HMOs)] is the Masada classification; however, several new classifications have been proposed,” Carley Vuillermin, MBBS, MPH, FRACS, said in her presentation at the Pediatric Orthopaedic Society of North America Annual Meeting.
To test the interrater reliability of the Masada, Jo and Gottschalk classifications, Vuillermin and colleagues analyzed 67 patients with a mean age of 8.7 years (101 forearms) who were diagnosed with HMO from July 2014 to October 2019. After initially using the Masada classification to review radiographic data from the patients, four pediatric hand surgeons from the Congenital Upper Limb Differences Registry reclassified the images using all three of the classifications. According to the study abstract, the surgeons were given educational materials with a detailed description of each original classification system.
Vuillermin and colleagues found poor interrater agreement for the initial Masada classification across all raters. Additionally, interrater agreement decreased for the Masada classification from first to second reading across all raters. Researchers noted the Gottschalk classification and the Jo classification yielded significantly higher interrater agreement, as both recorded Fliess’s kappa scores of 0.43 compared with 0.21 in the second reading of the Masada classification.
“We found that the Gottschalk classification offered more locations but lacked some of the most important features that we use as upper extremity surgeons, including radial head dislocation, bowing or shortening,” Vuillermin said. “In terms of the Jo classification, there were more options for locations provided and some patterns did incorporate radial head dislocation, which is important in our management decisions, although it did not capture lots of the multiple locations and combinations.”
“In all three classification systems, when being used in a registry setting for all patients presenting to outpatient clinics, we only found fair to moderate reliability, and there were high numbers of unclassifiable cases, and a more inclusive classification in perspective data collection is probably necessary,” Vuillermin concluded.
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Vuillermin C, et al. Paper 27. Presented at: Pediatric Orthopaedic Society of North America Annual Meeting; May 12-15, 2021; Dallas (hybrid meeting).
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