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5 Existen diferentes estudios que objetan la clasificación de las fracturas expuestas de Gustilo, muchos de ellos señalan la variabilidad interobservador y la falta de uniformidad en el diagnóstico. El objetivo del presente estudio fue determinar el nivel de concordancia diagnóstica inter e intraobservador así como el nivel de concordancia diagnóstica y nivel de aprendizaje de la clasificación de Gustilo y compararla con la clasificación de las fracturas abiertas de Aybar. Método. El estudio se realizó en 38 médicos residentes de la especialidad de Cirugía Ortopédica y traumatología de la Universidad Nacional Mayor de San Marcos utilizando para ello un pre y post-test en los cuales se evaluó imágenes de la fractura abierta; tanto el patrón fracturario como el daño de partes blandas. Resultados. Fueron analizados mediante el método estadístico de Kappa. Los resultados indicaron una correlación débil de la clasificación de Gustilo frente a una correlación muy moderada con respecto a Aybar. Conclusiones. La clasificación de Gustilo puede tener cierto carácter de ambigüedad debido a que sus tipos no son lo suficientemente excluyentes y objetivos. La clasificación de Aybar mostró buen nivel de concordancia diagnóstica y mejor nivel de aprendizaje lo que sugiere ser probablemente mas objetiva y sencilla de aplicar. Palabras claves : Clasificación de Gustilo, Clasificación de Aybar, Análisis estadístico Kappa.

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7 There exist different studies, wich the Gustilo classification of fractures, many of them point out the observer variability and the lack uniformity in the diagnostic. The goal of this study was to determine the level of inter and intraobserver diagnostic agreement and the level of understanding of the Gustilo classification and to compared it with Aybar s classification of open fractures. Method. The study was performed an 38 residents of Orthopaedics and Traumatology of the UNMSM by using a pre and post-test. They were shown X-ray films of open fractures and received information about injuries to the soft tissues. Results. They were analized by Kappa statistical method. The results showed a weak correlation of Gustilo s classification in respect of a moderate correlation as compared with Aybar s classification. Conclusions. Gustilo s classification may have a certain level of ambiguity because their types are not exclusive and objective enough. Aybar s classification shaved good level of diagnostic concordance and a good level of learning, wich may suggest that it is more objective and easier to use. Key words : Gustilo s classification, Aybar s classification, Kappa statistical method. '

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31 + + & + + & 7 7 Campbell. Cirugía Ortopédica. Vol.3 Novena Edición American Academy of Orthopaedic Surgeons. Orthopaedic Knowledge Update.Pág.108. Año Colton. British Editorial Society of Bone and Joint Surgery. Pág Año Aybar Montoya, Alfredo. Fijación Externa Descartable- FED. Pág Año Gustilo, Ramon. Fracturas y Luxaciones.Pág Año Aybar Montoya, Alfredo. Revista Mexicana de Ortopedia y Traumatología. Pág Año Brumback and Jones. MD. Baltimore, Maryland. The Journal of Bone and Joint Surgery. Vol 76.-A No 8, Agost Almanza Jimenez, Alejandro. IMMS. México. Revista Mexicana de Ortopedia y y Traumatología 1999, Set, Ruíz Martínez, Fernando. IMSS. México. Revista Mexicana de Ortopedia y Traumatología 1999, Oct Donald Garbuz. Classifications System in Orthopaedics. July/ August 2002 Article Abstracts Vol 10 Nro 4. Chapman. The Journal of Bone and Joint Surgery. Sept &C

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