Inter- and intra-observer reliability of a novel Lisfranc injury classification in comparison to the Myerson classification

Aim

We investigated the inter- and intra-observer reliability of the novel Column Involvement Severity System (CISS) in comparison to the commonly used Myerson classification for Lisfranc injuries.

Methods

Sixteen observers (orthopedic or trauma surgeons with experience in foot and ankle trauma) rated radiographs and computed tomography videos of 31 cases of patients treated at our level 1 trauma center between 2010 and 2020. Four weeks after completing the first rating session, eight observers (50%) rated the cases again. The inter- and intra-observer reliability for both classifications were assessed using intraclass correlation coefficients (ICC).

Results

ICC for Myerson classification was 0,277 (0,056–0,944) for interobserver and 0,505 (0,390–0,604) for intra-observer reliability. However, the Myerson classification was found to be non-applicable by at least 25% of observers in 48,4% of cases (range 0–63%). For the CISS classification, overall ICC was 0,455 (moderate) and 0,676 (substantial) for interobserver and intra-observer reliability respectively.

Conclusion

The Myerson classification was found to be non-applicable by a large number of observers. The CISS classification demonstrated better interobserver and intra-observer reliability. It may thus provide better communication about the injury severity and involvement of the three midfoot columns in Lisfranc injuries.