Reliability of a modified Gartland classification of supracondylar humerusfractures

Fracture-classification systems are used to recommend treatment and predict outcomes. In this study, a modified Gartland classification system of supr acondylar humerus fractures in children was assessed for interobserver and interobserver variability. Five observers classified radiographs of 50 cons ecutive children with extension supracondylar humerus fractures on three se parate occasions. After a 2-week interval, 90% of fractures were classified the same on both readings, with and intraobserver kappa value of 0.84. Aft er 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. Th e reliability of the Gartland classification for supracondylar humerus frac tures in children is better than that published for other fracture-classifi cation systems. However, 10% of the time, a second reading by the same obse rver is different. This makes treatment recommendations based only on fract ure type imprecise.