TABLE III.

Phase 2: Agreement in Fracture Characterization and Treatment Recommendations

	Among U.S. Surgeons*		Between Malawian OCOs and U.S. Surgeons†
	Percent Agreement	Fleiss Kappa‡	Percent Agreement	Cohen Kappa‡
Injury classification
Weber classification	86%	0.79 (0.66 to 0.93)
Osseous injury	78%	0.77 (0.67 to 0.87)
Syndesmotic injury	57%	0.35 (0.19 to 0.51)
Medial clear space	77%	0.65 (0.43 to 0.86)
Fracture characteristics
Nondisplaced	78%	0.68 (0.52 to 0.84)	80%	0.60 (0.38 to 0.82)
Displaced	73%	0.63 (0.47 to 0.79)	78%	0.57 (0.35 to 0.80)
Unstable	88%	0.83 (0.67 to 0.99)	65%	0.38 (0.09 to 0.66)
Dislocated	92%	0.76 (0.60 to 0.92)	80%	0.29 (0 to 0.66)
Treatment recommendation (operative vs. nonoperative)	90%	0.86 (0.69 to 1.00)	65%	0.38 (0.09 to 0.66)

^*Three foot and ankle fellowship-trained orthopaedic surgeons examined deidentified radiographs for each patient in Phase 2 and gave blinded, post hoc injury characteristics and treatment recommendations.

^†Consensus fracture characteristics and treatment recommendations among U.S. surgeons were then compared with the fracture characteristics and intended treatment plans formulated by the Malawian OCOs caring for the patients. Malawian OCOs were not asked to provide a Weber classification or describe the osseous and ligamentous injury on radiographs.

^‡The values are given as the kappa value, with the 95% CI in parentheses.