Mallo Gregory, Stanat Scott J C, Gaffney John
Department of Orthopedics, Stony Brook University Hospital, HSC T-18, Room 089, Stony Brook, NY 11794-8181, USA.
Orthopedics. 2010 Jan;33(1):19. doi: 10.3928/01477447-20091124-08.
The extension-type pediatric supracondylar humerus fracture accounts for nearly two-thirds of all pediatric hospitalizations due to elbow trauma. The Gartland classification guides the standard of care for treatment of this entity. Type I injuries are treated with cast immobilization while type II and III injuries are treated operatively. The reported interobserver reliability ranges from moderate to full agreement, which is on par with other frequently referenced classification systems such as Lauge-Hansen for adult ankle fractures. In this study, 4 fellowship-trained pediatric orthopedic surgeons reviewed radiographs of 72 pediatric supracondylar fractures and classified them based on Gartland's system. They recommended their preferred treatment of cast immobilization for type I fractures and of closed reduction and pinning in the operating room for type II and type III fractures. The interobserver and intraobserver reliability for each set of radiographs was then analyzed. There was moderate agreement comparing all fractures and comparing types I and II fractures, while there was full agreement for type III fractures. There was full agreement for the intraobserver reliability. The preferred treatment (casting vs operative intervention) differed in 35% of patients, if based on the fracture classification.
伸展型小儿肱骨髁上骨折占因肘部创伤而住院的小儿患者的近三分之二。加特兰分类法指导着该疾病的治疗标准。I型损伤采用石膏固定治疗，而II型和III型损伤则采用手术治疗。报告的观察者间可靠性从中度一致到完全一致不等，这与其他经常引用的分类系统（如用于成人踝关节骨折的劳格-汉森分类系统）相当。在本研究中，4名经过专科培训的小儿骨科医生对72例小儿肱骨髁上骨折的X线片进行了评估，并根据加特兰系统进行分类。他们建议I型骨折首选石膏固定治疗，II型和III型骨折首选在手术室进行闭合复位和穿针固定治疗。然后分析了每组X线片的观察者间和观察者内可靠性。在比较所有骨折以及比较I型和II型骨折时，一致性为中度，而在III型骨折中则为完全一致。观察者内可靠性为完全一致。如果根据骨折分类，35%的患者首选治疗方法（石膏固定与手术干预）有所不同。
