Download PDFOpen PDF in browserSystematic Rule-Based Regional Radiologic Classification of Traumatic Pelvic Ring Fractures: An Observer Variability Study3 pages•Published: January 5, 2026AbstractPurpose: The Young-Burgess pelvic ring classification system is commonly used for the classification of these fractures for treatment planning. In the emergency room, it is performed on a pelvic AP radiograph using general guidelines, whose results may vary between observers and may not be explainable. We aimed to validate a new rule-based regional anatomical system for systematic, explainable classification that is amenable to automation.Methods: The rule-based pelvic regions system divides each pelvic radiograph into 11 distinct, partially overlapping pelvic regions. Each region is independently evaluated for radiographic findings – normal or injured. The Young-Burgess class is then determined with rules that combine the pelvic region evaluations. Fifty pelvic radiographs were evaluated and classified into one of the Young-Burgess classes by three experienced orthopedic trauma surgeons. Each radiograph was assessed twice in separate sessions: once as a full image (Gestalt) and once with the pelvic regions only, presented in random locations to avoid providing spatial cues (Per-region). Inter-observer agreement was quantified with weighted kappa scores. Results: The Gestalt and the Per-region evaluations had comparable inter-observer agreement, with mean weighted kappa scores of 0.46 and 0.47 (ranges 0.40-0.61 and 0.39-0.56), respectively. The Per-region approach had slightly more consistent scores across different observer pairs. Conclusion: Performing Young-Burgess pelvic ring injury classification with a rule-based regional anatomical system yields observer agreement scores comparable to conventional whole-image evaluation. This suggests that machine learning methods using the new system may achieve results similar to human experts and provide more transparent and interpretable results than whole-image black box methods. Keyphrases: observer variability, pelvic ap x ray analysis, pelvic ring fractures, young burgess classification In: Joshua William Giles and Aziliz Guezou-Philippe (editors). Proceedings of The 25th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 8, pages 26-28.
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