Observer variation in the radiographic classification of fractures of the neck of the femur using Garden's system

Abstract

By means of Kappa statistics, we calculated the inter- and intra-observer variation in the classification of fractures of the neck of the femur according to Garden's system. Radiographs of 96 consecutive patients were assessed independently by six observers who agreed on classification for only 14 fractures (15%). The level of agreement was poor for the overall classification (Kappa = 0.39). When reducing Garden's system into non-displaced (Stage I and II) and displaced fractures (Stage III and IV) the level of agreement became acceptable (Kappa = 0.68). However, problems remain in distinguishing Stage II and Stage III fractures, and further improvements in the classification system are necessary.

Outcome of undisplaced and moderately displaced femoral neck fractures

“…This study provides evidence of the usefulness of classifying the fractures as being undisplaced or moderately displaced. Previous studies have shown that the Garden classification system is unreliable (Eliasson et al 1988, Frandsen et al 1988, Thomsen et al 1996, Bjorgul and Reikeras 2002, but the interobserver reliability may be acceptable when distinguishing between displaced and undisplaced fractures (Eliasson et al 1988, Frandsen et al 1988, Thomsen et al 1996, Bjorgul and Reikeras 2002. The significant difference in healing complications in our study indicates that moderately displaced fractures behave differently from undisplaced fractures.…”

“…They can be treated by various methods including hip compression screw, percutaneous pinning, two or three parallel screws, or arthroplasty (Bhandari et al 2003, Rogmark andJohnell 2006)-or in rare cases, nonoperatively (Cserhati et al 1996). Femoral neck fractures are commonly classified as undisplaced or displaced , as it has been shown that the reliability of the original staging of the Garden (1961) and Pauwels (1935) classifications is low (Frandsen et al 1988, Pryor 1995, Thomsen et al 1996. The undisplaced fractures are thought to be inherently stable and are commonly believed to have good healing potential (Pryor 1995).…”

Low interobserver reliability of radiographic signs predicting healing disturbance in displaced intracapsular fracture of the femoral neck

“…However, this classication has been shown to be unreliable (Frandsen et al 1986, Thomsen et al 1996 and it is therefore recommended that an intracapsular fracture should be classi ed as undisplaced or displaced (Eliasson et al 1988), but even this may not improve the agreement (Thomsen et al 1996). We found that the reliability of the simpli ed classi cation is better than that of the original.…”

Arthroplasty or internal fixation for displaced femoral neck fractures: which is the optimal alternative for elderly patients? A meta-analysis

“…We included only studies meeting the following criteria: randomised controlled trails comparing IF with arthroplasty; included patients aged 60 years or over with an acute displaced fracture of the femoral neck (Garden stage III or IV fractures) [28]; reported clinical outcomes, such as mortality, the rates of general complications, fracture-related complications and revision surgery. No language restriction was applied.…”