Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun;54(7):1180-1186.
doi: 10.1007/s00247-024-05935-3. Epub 2024 May 2.

Gartland classification concordance of supracondylar fractures among pediatric emergency medicine physicians, radiologists, and orthopedic surgeons

Rebecca J Schultz  1   2 , Jason Zarahi Amaral  3   4 , Callie S Bridges  3   4 , Joseph Y Allen  5   6 , Eric S Bih  7   8 , Andrea T Cruz  9 , Aharon Z Gladstein  3   4 , Erin B Henkel  5   6 , Steven J Kraus  7   8 , Brian G Smith  3   4 , Jon C Wall Jr  3   4 , J Herman Kan  10   11
Affiliations

Gartland classification concordance of supracondylar fractures among pediatric emergency medicine physicians, radiologists, and orthopedic surgeons

Rebecca J Schultz et al. Pediatr Radiol. 2024 Jun.

Abstract

Background: The modified Gartland classification is the most widely accepted grading method of supracondylar humeral fractures among orthopedic surgeons and is relevant to identifying fractures that may require surgery.

Objective: To assess the interobserver reliability of the modified Gartland classification among pediatric radiologists, pediatric orthopedic surgeons, and pediatric emergency medicine physicians.

Materials and methods: Elbow radiographs for 100 children with supracondylar humeral fractures were retrospectively independently graded by two pediatric radiologists, two pediatric orthopedic surgeons, and two pediatric emergency medicine physicians using the modified Gartland classification. A third grader of the same subspecialty served as a tie-breaker as needed to reach consensus. Readers were blinded to one another and to the medical record. The modified Gartland grade documented in the medical record by the treating orthopedic provider was used as the reference standard. Interobserver agreement was assessed using kappa statistics.

Results: There was substantial interobserver agreement (kappa = 0.77 [95% CI, 0.69-0.85]) on consensus fracture grade between the three subspecialties. Similarly, when discriminating between Gartland type I and higher fracture grades, there was substantial interobserver agreement between specialties (kappa = 0.77 [95% CI, 0.66-0.89]). The grade assigned by pediatric radiologists differed from the reference standard on 15 occasions, pediatric emergency medicine differed on 19 occasions, and pediatric orthopedics differed on 9 occasions.

Conclusion: The modified Gartland classification for supracondylar humeral fractures is reproducible among pediatric emergency medicine physicians, radiologists, and orthopedic surgeons.

Keywords: Child; Consensus; Humeral fractures; Musculoskeletal; Orthopedics; Radiograph; Reliability.

PubMed Disclaimer

References

    1. Gartland JJ (1959) Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 109:145–154 - PubMed
    1. Wilkins KE (1984) Fractures and dislocations of the elbow region. In: Rockwood C, King R (eds) Fractures in children. Lippincott Williams & Wilkins, Philadelphia, pp 363–575
    1. Mallo G, Stanat SJC, Gaffney J (2010) Use of the Gartland classification system for treatment of pediatric supracondylar humerus fractures. Orthopedics 33:19. https://doi.org/10.3928/01477447-20091124-08 - DOI - PubMed
    1. Barton KL, Kaminsky CK, Green DW et al (2001) Reliability of a modified Gartland classification of supracondylar humerus fractures. J Pediatr Orthop 21:27 - DOI - PubMed
    1. Rocha ITS, Faria AdeS, Filho CF, Rocha MA (2015) Reproducibility of the AO/ASIF and Gartland classifications for supracondylar fractures of the humerus in children. Rev Bras Ortop 50:266–269. https://doi.org/10.1016/j.rboe.2015.05.001 - DOI - PubMed - PMC

LinkOut - more resources