Purpose or Case Report: Our institution employs the modified Gartland classification system for operative and non-operative supracondylar humeral fracture (SCHF) communication. The purpose of our study is to assess the inter-observer reliability of the Gartland classification between pediatric radiologists, orthopedic surgeons, and pediatric emergency physicians.
Methods & Materials: Kappa coefficient was used to assess inter-observer reliability between 3 subspecialty teams for 100 supracondylar fractures which were seen and treated at our institution (40 type I, 30 type II, and 30 type III fractures- average age 6.1 years (SD 2.5 years). Consensus review was performed by 3 member pediatric subspecialty trained teams in emergency medicine (EM), radiology, and pediatric orthopedic surgery. All reviewers were blinded to final diagnosis and treatment outcome. A Kappa value between 0.4-0.59 is considered moderate, 0.60-0.80 was considered substantial, and >0.81 was considered excellent agreement.
Results: For subspecialty consensus review for all three pediatric subspecialties, there was 77% agreement and substantial inter-observer agreement with overall kappa of 0.768 (95% CI: 0.687 - 0.848), p<0.001. Orthopedics and radiology had 88% agreement, Kappa of 0.863 (95% CI 0.788 - 0.937). EM and orthopedics had 84% agreement, Kappa of 0.813 (95% CI 0.727 - 0.899). EM and radiology had 82% agreement with Kappa of 0.792 (95% CI 0.703 - 0.881). The individual kappa values for type I, type II, and type III were 0.772 (95% CI 0.659 - 0.885), 0.666 (95% CI .0553 - 0.779), and 0.882 (95% CI 0.768 - 0.995) respectively.
Conclusions: The modified Gartland classification system is a reliable and effective communication tool between pediatric subspecialty radiologists, orthopedic surgeons, and emergency physicians. Effective emergency triage of operative and non-operative supracondylar fractures requires an accepted and efficient communication tool between different subspecialty teams. This study establishes that surgical and non-surgical subspecialty teams can rely on the modified Gartland classification to communicate which children may be electively seen by pediatric orthopedists as outpatients (Gartland I) versus those that require immediate surgical consultation (Gartland II and III).