Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 5, pp 645–650 | Cite as

The intra- and interobserver reliability of the Tile AO, the Young and Burgess, and FFP classifications in pelvic trauma

  • Josephine Berger-GrochEmail author
  • Darius M. Thiesen
  • Lars G. Grossterlinden
  • Jan Schaewel
  • Florian Fensky
  • Maximilian J. Hartel
Trauma Surgery



Several different systems of classification have been developed to understand the complexity of pelvic ring fractures, to facilitate communication between physicians and to support the selection of appropriate therapeutic measures. The purpose of this study was to measure the inter- and intraobserver reliability of Tile AO, Young and Burgess, and FFP classification in pelvic ring fractures. The Rommens classification system (FFP) is analyzed for the first time.

Materials and methods

Four reviewers (2 × senior pelvic trauma surgeon, 1 × resident, 1 × medical student) separately analyzed and classified 154 CT scans of patients with pelvic fracture. The Tile AO, the Young and Burgess, and the FFP classifications (subgroup with patients ≥ 60 years) were compared. Another blinded re-evaluation was carried out after 2 months to determine intraobserver reliability.


The overall interobserver agreement was fair for all classification systems (ICC: OTA 0.55, Young and Burgess 0.42, FFP 0.54). For specific categories, (e.g. type B or C fractures), there was a substantial agreement between the experienced surgeons (kappa: OTA 0.64, Young and Burgess 0.62, FFP 0.68). For inexperienced observers, there was a fair agreement in all systems (kappa: OTA 0.23, Young and Burgess 0.23, FFP 0.36).


All three classifications reach their maximum reliability with advanced expertise in the surgery of pelvic fractures. The novel FFP classification has proved to be at least equivalent when directly compared to the established systems. The FFP classification system showed substantial reliability in patients older than 60 years.


Pelvic trauma Classification Interobserver reliability FFP OTA Young and Burgees 



There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures involving human participants were in accordance with the ethical standards of the institutional and national research committee (reference number: WF-009/18) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

402_2019_3123_MOESM1_ESM.pdf (612 kb)
Supplementary material 1 (PDF 611 KB)
402_2019_3123_MOESM2_ESM.xlsx (19 kb)
Supplementary material 2 (XLSX 18 KB)


  1. 1.
    Buller LT, Best MJ, Quinnan SM (2016) A nationwide analysis of pelvic ring fractures: incidence and trends in treatment, length of stay, and mortality. Geriatr Orthop Surg Rehabil 7:9–17. CrossRefGoogle Scholar
  2. 2.
    Pereira GJC, Damasceno ER, Dinhane DI et al (2017) Epidemiology of pelvic ring fractures and injuries. Rev Bras Ortop 52:260–269. CrossRefGoogle Scholar
  3. 3.
    Kannus P, Parkkari J, Niemi S, Sievänen H (2015) Low-trauma pelvic fractures in elderly finns in 1970–2013. Calcif Tissue Int 97:577–580. CrossRefGoogle Scholar
  4. 4.
    Krappinger D, Kammerlander C, Hak DJ, Blauth M (2010) Low-energy osteoporotic pelvic fractures. Arch Orthop Trauma Surg 130:1167–1175. CrossRefGoogle Scholar
  5. 5.
    Studer P, Suhm N, Zappe B et al (2013) Pubic rami fractures in the elderly–a neglected injury? Swiss Med Wkly 143:w13859. Google Scholar
  6. 6.
    Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E (2003) Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Jt Bone Spine 70:287–289CrossRefGoogle Scholar
  7. 7.
    Yang N-P, Chan C-L, Chu D et al (2014) Epidemiology of hospitalized traumatic pelvic fractures and their combined injuries in Taiwan: 2000–2011 National Health Insurance data surveillance. Biomed Res Int 2014:878601. Google Scholar
  8. 8.
    Tile M (1996) Acute pelvic fractures: I. causation and classification. J Am Acad Orthop Surg 4:143–151CrossRefGoogle Scholar
  9. 9.
    Marsh JL, Slongo TF, Agel J et al Fracture and dislocation classification compendium—2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21:S1-133Google Scholar
  10. 10.
    Young JW, Burgess AR, Brumback RJ, Poka A (1986) Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160:445–451. CrossRefGoogle Scholar
  11. 11.
    Rommens PM, Hofmann A (2013) Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 44:1733–1744. CrossRefGoogle Scholar
  12. 12.
    Gabbe BJ, Esser M, Bucknill A et al (2013) The imaging and classification of severe pelvic ring fractures: experiences from two level 1 trauma centres. Bone Jt J 95–B:1396–1401. CrossRefGoogle Scholar
  13. 13.
    Furey AJ, O’Toole RV, Nascone JW et al (2009) Classification of pelvic fractures: analysis of inter- and intraobserver variability using the Young–Burgess and tile classification systems. Orthopedics 32:401. CrossRefGoogle Scholar
  14. 14.
    Koo H, Leveridge M, Thompson C et al (2008) Interobserver reliability of the young–burgess and tile classification systems for fractures of the pelvic ring. J Orthop Trauma 22:379–384. CrossRefGoogle Scholar
  15. 15.
    Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46. CrossRefGoogle Scholar
  16. 16.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefGoogle Scholar
  17. 17.
    Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428CrossRefGoogle Scholar
  18. 18.
    Cicchetti DV, Sparrow SA (1981) Developing criteria for establishing interrater reliability of specific items: applications to assessment of adaptive behavior. Am J Ment Defic 86:127–137Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Trauma-, Hand-, and Reconstructive SurgeryUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of Orthopedics, Trauma-and Spine SurgeryAsklepios Hospital Hamburg-AltonaHamburgGermany

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