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J Am Acad Orthop Surg, Vol 10, No 4, July/August 2002, 290-297.
© 2002 the American Academy of Orthopaedic Surgeons
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Classification Systems in Orthopaedics

Donald S. Garbuz, MD, MHSc, FRCSC, Bassam A. Masri, MD, FRCSC, John Esdaile, MD, MPH, FRCPC and Clive P. Duncan, MD, FRCSC

Dr. Garbuz is Assistant Professor, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada. Dr. Masri is Associate Professor and Head, Division of Reconstructive Orthopaedics, University of British Columbia. Dr. Esdaile is Professor and Head, Division of Rheumatology, University of British Columbia. Dr. Duncan is Professor and Chairman, Department of Orthopaedics, University of British Columbia.

Reprint requests: Dr. Garbuz, Laurel Pavilion, Third Floor, 910 West Tenth Avenue, Vancouver, BC, Canada V5Z 4E3.

Classification systems help orthopaedic surgeons characterize a problem, suggest a potential prognosis, and offer guidance in determining the optimal treatment method for a particular condition. Classification systems also play a key role in the reporting of clinical and epidemiologic data, allowing uniform comparison and documentation of like conditions. A useful classification system is reliable and valid. Although the measurement of validity is often difficult and sometimes impractical, reliability—as summarized by intraobserver and interobserver reliability—is easy to measure and should serve as a minimum standard for validation. Reliability is measured by the kappa value, which distinguishes true agreement of various observations from agreement due to chance alone. Some commonly used classifications of musculoskeletal conditions have not proved to be reliable when critically evaluated.




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