Introduction: Classification systems guide surgical planning. We reviewed the accuracy of interpreting plain radiographs to classify distal radius fractures. Methods: Pre-operative radiographs of 24 consecutive distal radius fractures were classified using Frykman and AO methods. Classification was repeated intra-operatively under direct vision for comparison. Results: Mean age of the patients was 51 years. Pre-operative Frykman scores and AO grades were underestimated, compared with intra-operative visual classification (p < 0.001). One over-estimate occurred, while only 3 of 24 cases were classified correctly pre-operatively. Conclusion: Sensitivity of radiographs to classify Frykman or AO grades was 12.5%, indicating interpretation using plain radiographs alone is often inadequate.
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