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Reproducibility of the Gartland classification for supracondylar humeral fractures in children
J Heal1, M Bould, J Livingstone
1Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom.
Insights
The Gartland classification for pediatric supracondylar humeral fractures shows moderate inter-observer agreement, with poor reliability for Type I fractures. Surgeons should focus on displacement assessment over this classification.
Area of Science:
- Orthopaedic surgery
- Pediatric orthopaedics
- Radiographic classification
Background:
- Supracondylar humeral fractures are common in children.
- The Gartland classification is widely used for grading these fractures.
- Assessing classification reliability is crucial for treatment decisions.
Purpose of the Study:
- To evaluate the intra- and inter-observer reproducibility of the Gartland radiographic classification (Wilkins modification) for pediatric supracondylar humeral fractures.
Main Methods:
- Four orthopaedic surgeons independently graded 50 pediatric supracondylar humeral fractures using anteroposterior and lateral radiographs.
- Fractures were classified twice by each surgeon using the Gartland classification.
- Intra- and inter-observer agreement were analyzed using Kappa values.
Main Results:
- Moderate inter-observer agreement was observed overall.
- Poor agreement was noted for Type I fractures, and fair to moderate agreement for Type II.
- Good to very good agreement was found for Type III fractures and the flexion group.
- Intra-observer agreement was consistently good to very good.
Conclusions:
- The Gartland classification demonstrates variable reproducibility in pediatric supracondylar humeral fractures.
- Reliability is particularly low for Type I and Type II fractures.
- Treatment decisions for these fractures may benefit more from direct assessment of displacement rather than strict adherence to the Gartland classification.
Purpose:
To evaluate the intra- and inter-observer reproducibility of the Gartland radiographic classification for supracondylar humeral fractures in children.
Methods:
Anteroposterior and lateral radiographs of 50 supracondylar humeral fractures in children were graded on 2 separate occasions by 4 orthopaedic surgeons according to the Wilkins modification of the Gartland classification. Data were analysed by calculating the Kappa values for intra- and inter-observer agreement to indicate the reproducibility of the classification.
Results:
There was moderate inter-observer agreement, except for poor agreement over type I fractures. Type II fractures only showed fair to moderate agreement. Type III fractures and the flexion group showed good to very good agreement. Intra-observer agreement was good to very good.
Conclusion:
Surgeons should treat paediatric supracondylar humeral fractures based on an assessment of the degree of displacement rather than by employing the Gartland classification.
