The reliability of a Garden, AO and simple II stage classifications for intracapsular hip fractures.

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

[Indexed for MEDLINE] 7. Orthop Traumatol Surg Res. 2012 Jun;98(4):405-8. doi: 10.1016/j.otsr.2012.02.003. Epub 2012 May 3. The reliability of a simplified Garden classification for intracapsular hip fractures. Van Embden D(1), Rhemrev SJ, Genelin F, Meylaerts SA, Roukema GR. Author information: (1)Department of Surgery, Medisch Centrum Haaglanden, Lijnbaan 32, 2512 VA, The Hague, The Netherlands. daphnevanembden@hotmail.com Comment in Acta Orthop. 2016 Jun;87(3):252-6. doi: 10.3109/17453674.2016.1155253. BACKGROUND: The Garden classification is used to classify intracapsular proximal femur fractures. The reliability of this classification is poor and several authors advise a simplified classification of intracapsular hip fractures into non-displaced and displaced fractures. However, this proposed simplified classification has never been tested for its reliability. HYPOTHESIS: We estimate simplifying the classification of femoral neck fractures will lead to a higher inter-observer agreement. MATERIALS AND METHODS: Ten observers, trauma surgeons and residents, from two different institutes classified 100 intracapsular femoral neck fractures. The inter-observer agreements were calculated using the multi-rater Fleiss' kappa. RESULTS: The inter-observer kappa for the Garden classification was 0.31. An agreement of κ0.52 was observed if the Garden classification was simplified and the fractures were classified by our observers as 'non-displaced' or 'displaced'. No difference in reliability was seen for the use of the four-grade Garden classification as well as the simplified classification between trauma surgeons and residents. DISCUSSION: Classification of intracapsular hip fractures according to the four-grade Garden classification is unreliable. The reliability of classification improves when the Garden classification is simplified in a classification using the terms: 'non-displaced' or 'displaced'. LEVEL OF EVIDENCE: Level IV. Diagnostic retrospective study. Copyright © 2012 Elsevier Masson SAS. All rights reserved. DOI: 10.1016/j.otsr.2012.02.003