Development and Evaluation Process of a Pediatric Long-Bone Fracture Classification Proposal

Abstract

Background and Purpose:

A pediatric long-bone fracture classification proposal was developed following the principle of the Müller AO classification long bones for adults and assessed for reliability and accuracy in a series of four pilot agreement studies (classification sessions).

Material and Methods:

Six surgeons independently classified 136 radius fractures using digitalized radiographs. Reliability and accuracy were quantified using Kappa and Latent Class Modeling, respectively.

Results:

Results from the last two sessions are presented whereby fractures were classified as epiphyseal, metaphyseal or diaphyseal. In session 3, the overall Kappa was 0.78 and pairwise Kappa ranged between 0.74 and 0.95. Surgeons were overall 85.7–99.5% accurate. In session 4, the overall Kappa was 0.98 and pairwise Kappa ranged between 0.95 and 0.99. Surgeons were overall 98.8–99.5% accurate.

Conclusion:

The systematic implementation of pilot agreement studies and use of Latent Class Modeling methodology for the development and evaluation of fracture classification systems in orthopedics are encouraged.