Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

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.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

All data collected was anonymized and stored in a password-protected Excel spreadsheet to protect patient confidentiality and privacy. The datasets generated and/or analyzed during the current study are available upon reasonable request from the corresponding author.

References

  1. Gartland JJ (1959) Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 109:145–154

    CAS  PubMed  Google Scholar 

  2. 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

    Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. Barton KL, Kaminsky CK, Green DW et al (2001) Reliability of a modified Gartland classification of supracondylar humerus fractures. J Pediatr Orthop 21:27

    Article  CAS  PubMed  Google Scholar 

  5. 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

    Article  PubMed  PubMed Central  Google Scholar 

  6. Teo TL, Schaeffer EK, Habib E et al (2019) Assessing the reliability of the modified Gartland classification system for extension-type supracondylar humerus fractures. J Child Orthop 13:569–574. https://doi.org/10.1302/1863-2548.13.190005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159. https://doi.org/10.2307/2529310

    Article  CAS  PubMed  Google Scholar 

  8. Houshian S, Mehdi B, Larsen MS (2001) The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci 6:312–315. https://doi.org/10.1007/s007760100024

    Article  CAS  PubMed  Google Scholar 

  9. Olmsted MG, Lessem S, Powell R et al (2023) Methodology: U.S. news & world report best children’s hospitals 2023–24. https://health.usnews.com/media/best-hospitals/BCH_Methodology_2023-2024.pdf. Accessed 3 Jan 2024

  10. Leung S, Paryavi E, Herman MJ et al (2018) Does the modified Gartland classification clarify decision making? J Pediatr Orthop 38:22. https://doi.org/10.1097/BPO.0000000000000741

    Article  PubMed  Google Scholar 

  11. Heal J, Bould M, Livingstone J et al (2007) Reproducibility of the Gartland classification for supracondylar humeral fractures in children. J Orthop Surg (Hong Kong) 15:12–14. https://doi.org/10.1177/230949900701500104

    Article  CAS  PubMed  Google Scholar 

  12. Hemberg JL, Drapkin Z, Klatt J (2021) Referral of pediatric patients with isolated fractures to a tertiary children’s hospital who did not require emergent intervention. Pediatrics 147:824. https://doi.org/10.1542/peds.147.3MA8.824a

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics Surgery, Texas Children’s Hospital (Texas Medical Center), Mark Wallace Tower, 6Th Floor, 6621 Fannin Street, Houston, TX, 77030, USA

    Rebecca J. Schultz, Jason Zarahi Amaral, Callie S. Bridges, Aharon Z. Gladstein, Brian G. Smith & Jon C. Wall Jr.

  2. Department of Orthopedics, Baylor College of Medicine, Houston, TX, USA

    Rebecca J. Schultz, Jason Zarahi Amaral, Callie S. Bridges, Aharon Z. Gladstein, Brian G. Smith & Jon C. Wall Jr.

  3. Division of Emergency Medicine, Texas Children’s Hospital, Houston, TX, USA

    Joseph Y. Allen & Erin B. Henkel

  4. Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Joseph Y. Allen & Erin B. Henkel

  5. Department of Radiology, Texas Children’s Hospital (Texas Medical Center), West Tower, 4Th Floor, 6621 Fannin Street, Houston, TX, 77030, USA

    Eric S. Bih, Steven J. Kraus & J. Herman Kan

  6. Department of Radiology, Baylor College of Medicine, Houston, TX, USA

    Eric S. Bih, Steven J. Kraus & J. Herman Kan

  7. Divisions of Emergency Medicine and Infectious Diseases, Baylor College of Medicine, Houston, TX, USA

    Andrea T. Cruz

Authors
  1. Rebecca J. Schultz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jason Zarahi Amaral
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Callie S. Bridges
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph Y. Allen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric S. Bih
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrea T. Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aharon Z. Gladstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Erin B. Henkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Steven J. Kraus
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Brian G. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jon C. Wall Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. J. Herman Kan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors substantially contributed to the conception, design, execution, and writing of this manuscript. All Authors have reviewed and approved the final manuscript. RJS: conceptualization, methodology, validation, formal analysis, investigation, resources, data curation, writing- original draft, writing- review and editing, visualization, project administration. JZA: conceptualization, methodology, formal analysis, investigation, writing- review and editing, visualization. CSB: conceptualization, methodology, investigation, resources, data curation, writing- review and editing. JYA: investigation, writing- review and editing, image interpretation. ESB: investigation, writing- review and editing, image interpretation. ATC: investigation, writing- review and editing, image interpretation. AZG: investigation, writing- review and editing, image interpretation. EBH: investigation, writing- review and editing, image interpretation. SJK: investigation, writing- review and editing, image interpretation. BGS: investigation, writing- review and editing, image interpretation. JCW: investigation, writing- review and editing, image interpretation. JHK: conceptualization, methodology, validation, investigation, resources, writing- original draft, writing- review and editing, visualization, supervision, project administration.

Corresponding authors

Correspondence to Rebecca J. Schultz or J. Herman Kan.

Ethics declarations

Conflicts of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schultz, R.J., Amaral, J.Z., Bridges, C.S. et al. Gartland classification concordance of supracondylar fractures among pediatric emergency medicine physicians, radiologists, and orthopedic surgeons. Pediatr Radiol (2024). https://doi.org/10.1007/s00247-024-05935-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00247-024-05935-3

Keywords

Search

Navigation