Peterson vs. Salter Harris physeal fracture classification systems: How consistent are they?

Area of Science:

• Orthopedics
• Radiology
• Pediatric Medicine

Background:

• The Salter-Harris (S-H) classification is standard for physeal fractures.
• The Peterson classification addresses fracture patterns beyond S-H, including metaphyseal extension and open injuries.
• Comparing the reliability of these classifications is crucial for improved clinical interpretation.

Purpose of the Study:

• To compare the intra- and interobserver agreement of the Salter-Harris (S-H) and Peterson classifications for physeal fractures.
• To evaluate the diagnostic consistency of two widely used fracture classification systems.

Main Methods:

• A cross-sectional study analyzed 100 physeal fracture radiographs (AP and lateral views).
• Five pediatric orthopedic surgeons and five residents classified fractures using S-H and Peterson systems on two separate occasions (8-week interval).
• Intra- and interobserver agreement were assessed using Kappa statistics and percentage agreement.

Main Results:

• Intraobserver agreement for S-H was κ=0.66 (experts) and 0.61 (residents); for Peterson, κ=0.67 (experts) and 0.61 (residents).
• Mean agreement percentages were 84.5% for S-H and 83.9% for Peterson (p=0.8).
• Overall interobserver agreement was similar for both classifications (S-H: κ=0.57-0.63; Peterson: κ=0.58-0.62).

Conclusions:

• The Salter-Harris and Peterson classifications exhibit comparable reliability for physeal fractures.
• Both systems demonstrate moderate-to-substantial interobserver agreement.
• No significant differences were found in overall agreement percentages between the two classifications.