Reliability of a Modified Gartland Classification of Supracondylar Humerus Fractures

Abstract

Fracture-classification systems are used to recommend treatment and predict outcomes. In this study, a modified Gartland classification system of supracondylar humerus fractures in children was assessed for intraobserver and interobserver variability. Five observers classified radiographs of 50 consecutive children with extension supracondylar humerus fractures on three separate occasions. After a 2-week interval, 90% of fractures were classified the same on both readings, with and intraobserver kappa value of 0.84. After a 36-week interval, 89% of the fractures were classified the same, with a kappa value of 0.81. Interobserver reliability was evaluated by pairwise comparison among observers, resulting in an overall kappa value of 0.74. The reliability of the Gartland classification for supracondylar humerus fractures in children is better than that published for other fracture-classification systems. However, 10% of the time, a second reading by the same observer is different. This makes treatment recommendations based only on fracture type imprecise.

Fractures of the coronoid: morphology based upon computer tomography scanning

“…3,22 Other investigations in the orthopedic literature have published kappa coefficients in evaluation of inter-and intra-observer reliability for classification systems. 5,7,14,20,24,27,35,37 Our intra-and interobserver reliability for this series compares favorably to other classification systems commonly used in orthopedic surgery. In contrast to the reliability seen in our series, the Neer classification system for proximal humerus fractures, which is considered to have poor inter-and intra-observer reliability, has been characterized by a kappa coefficient of 0.48-0.52 and 0.64-0.66, respectively.…”

“…[1][2][3][4][5][6]. Although these patterns were identified without specific regard to existing classification systems, we did identify fractures as previously described, according to the Regan-Morrey classification, as well as that of a more recently described system by O'Driscoll et al 28,31 As the Regan-Morrey classification system for coronoid fractures is the most commonly used system, and because it is simple, readily applicable, and familiar to most orthopedic surgeons, we attempted to describe these patterns according to the most closely corresponding pattern of the Regan-Morrey system.…”

“…7,35 The Gartland classification system for pediatric supracondylar humerus fractures has been characterized by a kappa coefficient of 0.521-0.74 and 0.723-0.84 for, respectively, inter-and intraobserver reliability. 5,24 Inter-observer kappa coefficients for ankle fracture classification systems have been reported as 0.49-0.60 for the Lauge-Hansen classification system and 0.56-0.58 for the Weber classification. 37 Poor interobserver reliability to detect union of scaphoid fractures was reported by Dias et al with a kappa rating of 0.386, while intra-observer reliability was better at 0.705.…”

Outcome of Gartland type II and type III supracondylar fractures treated by Blount’s technique

“…Because of the imprecision of the Gartland's original classification, we preferred to use the modified Gartland classification whose reliability has already been proved 21. A Gartland type II fracture is displaced (by >2 mm), and the posterior cortex is presumably intact, but hinged 2.…”

Predictors of Failure of Nonoperative Treatment for Type-2 Supracondylar Humerus Fractures

“…1 The Wilkins modification of the Gartland classification has been found to have reasonable reliability and is commonly used to quantify the degree of displacement in extension-type fractures. 2 Type-1 fractures are nondisplaced, type-2 fractures exhibit extension of the distal fragment with the posterior cortex intact but hinged, and type-3 fractures exhibit extension of the distal fragment with disruption of the posterior cortex. 3 Type-1 fractures may be treated in a cast with predictably good healing.…”