Skip to main content

Advertisement

SpringerLink
Log in

Analysis of the Intra- and Inter-observer Reliabilities of Delbet Classification: Is Simplification Required

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Objective

This study aims to investigate the intra- and inter-reliabilities of Delbet classification and whether simplifying the classification improves reliability.

Method

The Radiographs of 58 patients under 16 years old diagnosed with pediatric hip fractures between January 2012 and January 2020 were evaluated. Two separate Microsoft® PowerPoint (PPT) presentations consisting of 58 slides for Delbet’s classification and its simplified form were prepared in which the order of cases was randomized and blinded. Then five orthopedic surgeons with different years of experience (more than 15 years of surgical experience were accepted experienced group) in pediatric trauma surgery evaluated the presentations two times one month apart.

Results

In the inter-observer reliability analysis, a moderate agreement for the classical Delbet classification and a substantial agreement for the simplified Delbet classification was found in both evaluations. As a result of the intra-observer reliability analysis, there was substantial agreement in four observers, moderate agreement in one observer for the classical Delbet classification and substantial agreement in two observers, very good agreement in three observers for the simplified Delbet classification. The experience was not effective on agreement levels in the intra-observer reliability analysis of the classical Delbet classification system. The inter-reliability values of the less experienced group in the simplified classification were much higher than the classical Delbet classification.

Conclusion

The simplification of the Delbet classification provides a significant increase in inter-observer reliability levels, especially in less experienced orthopedics and traumatology specialists, and a significant increase in intra-observer reliability levels.

Level of Evidence

Level III, diagnostic study.

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

Similar content being viewed by others

Data Availability

Data can be available from corresponding author.

References

  1. Beaty, J. H., & Kasser, J. R. (2010). Rockwood and Wilkins. Fractures in children (pp. 769–796). William and Wilkins, Walter Klower/Lippincott.

    Google Scholar 

  2. Colonna, P. C. (1928). Fracture of the neck of the femur in childhood: A report of six cases. Annals of Surgery, 88, 902–907.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Moon, E. S., & Mehlman, C. T. (2006). Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and metaanalysis of 360 cases. Journal of Orthopaedic Trauma, 20, 323–329.

    Article  PubMed  Google Scholar 

  4. Canale, S. T., & Bourland, W. L. (1977). Fracture of the neck and intertrochanteric region of the femur in children. Journal of Bone and Joint Surgery American Volume, 59, 431–443.

    Article  CAS  PubMed  Google Scholar 

  5. Garden, R. S. (1961). Low-angle fixation in fractures of the femoral neck. Journal of Bone and Joint Surgery British Volume, 43, 647–663.

    Article  Google Scholar 

  6. Van Embden, D., Rhemrev, S. J., Genelin, F., Meylaerts, S. A. G., & Roukema, G. R. (2012). The reliability of a simplified Garden classification for intracapsular hip fractures. Orthopaedics & Traumatology, Surgery & Research, 98(4), 405–408.

    Article  Google Scholar 

  7. Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorial data. Biometrics, 33, 159.

    Article  CAS  PubMed  Google Scholar 

  8. Turgut, A., Kumbaracı, M., Kalenderer, Ö., İlyas, G., Bacaksız, T., & Karapınar, L. (2016). Is surgeons’ experience important on intra- and inter-observer reliability of classifications used for adult femoral neck fracture? Acta Orthopaedica et Traumatologica Turcica, 50(6), 601–605.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kumbaraci, M., Turgut, A., Bacaksiz, T., Ilyas, G., Bilgin, E., & Kalenderer, Ö. (2021). Direct radiography following fracture reduction improves the reliability of Pauwels classification. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca, 88(1), 63–68.

    Article  CAS  PubMed  Google Scholar 

  10. Van Embden, D., Roukema, G. R., & Rhemrev, S. J. (2011). The Pauwels classification for intracapsular hip fractures: Is it reliable? Injury, 42(11), 1238–1240.

    Article  PubMed  Google Scholar 

  11. Blundell, C. M., Parker, M. J., Pryor, G. A., Hopkinson-Woolley, J., & Bhonsle, S. S. (1998). Assessment of the AO classification of intracapsular fractures of the proximal femur. Journal of Bone and Joint Surgery British Volume, 80(4), 679–683.

    Article  CAS  PubMed  Google Scholar 

  12. Yeranosian, M., Horneff, J. G., Baldwin, K., & Hosalkar, H. S. (2013). Factors affecting the outcome of fractures of the femoral neck in children and adolescents: A systematic review. The Bone & Joint Journal, 95-b(1), 135–142.

    Article  CAS  Google Scholar 

  13. Nötzli, H. P., Wyss, T. F., Stoecklin, C. H., Schmid, M. R., Treiber, K., & Hodler, J. (2002). The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. Journal of Bone and Joint Surgery British Volume, 84(4), 556–560.

    Article  PubMed  Google Scholar 

  14. Moon, E. S., & Mehlman, C. T. (2006). Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. Journal of Orthopaedic Trauma, 20(5), 323–329.

    Article  PubMed  Google Scholar 

  15. McHugh, M. L. (2012). Interrater reliability: The kappa statistic. Biochemia Medica (Zagreb), 22(3), 276–282.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopedics and Traumatology Department, University of Health Sciences, İzmir Tepecik Health Research Center, 1140/1 street no: 1, Konak/Izmir, Turkey

    Muhammet Bozoğlan, Mert Kumbaraci, Safa Bozkurt & Ali Turgut

  2. Orthopedics and Traumatology Department, Medicana International Hospital, Bursa, Odunluk Mah., İzmir Yolu Cad. No: 41, 16110, Nilüfer/Bursa, Turkey

    Gökhan Cansabuncu

Authors
  1. Muhammet Bozoğlan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gökhan Cansabuncu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mert Kumbaraci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Safa Bozkurt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Turgut
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muhammet Bozoğlan.

Ethics declarations

Conflict of interest

We state that all of the authors had made substantial contributions to; the conception and design of the study, acquisition of data, or analysis and interpretation of data. The final version of the manuscript had been read and approved by all of the authors. Our manuscript is not under consideration by another journal, is not in press in any other format, and none of its contents have been previously published. The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript.

Ethical standard statement

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed consent

For this type of study, informed consent is not required.

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

Bozoğlan, M., Cansabuncu, G., Kumbaraci, M. et al. Analysis of the Intra- and Inter-observer Reliabilities of Delbet Classification: Is Simplification Required. JOIO 57, 1478–1484 (2023). https://doi.org/10.1007/s43465-023-00961-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-023-00961-z

Keywords

Search

Navigation