Department of Orthopedic Surgery, Stavanger University Hospital, Stavanger, Norway.
Acta Orthop. 2013 Apr;84(2):207-12. doi: 10.3109/17453674.2012.752692. Epub 2012 Dec 18.
Guidelines for fracture treatment and evaluation require a valid classification. Classifications especially designed for children are available, but they might lead to reduced accuracy, considering the relative infrequency of childhood fractures in a general orthopedic department. We tested the reliability and accuracy of the Müller classification when used for long bone fractures in children.
We included all long bone fractures in children aged < 16 years who were treated in 2008 at the surgical ward of Stavanger University Hospital. 20 surgeons recorded 232 fractures. Datasets were generated for intra- and inter-rater analysis, as well as a reference dataset for accuracy calculations. We present proportion of agreement (PA) and kappa (K) statistics.
For intra-rater analysis, overall agreement (κ) was 0.75 (95% CI: 0.68-0.81) and PA was 79%. For inter-rater assessment, K was 0.71 (95% CI: 0.61-0.80) and PA was 77%. Accuracy was estimated: κ = 0.72 (95% CI: 0.64-0.79) and PA = 76%.
The Müller classification (slightly adjusted for pediatric fractures) showed substantial to excellent accuracy among general orthopedic surgeons when applied to long bone fractures in children. However, separate knowledge about the child-specific fracture pattern, the maturity of the bone, and the degree of displacement must be considered when the treatment and the prognosis of the fractures are evaluated.
骨折治疗和评估指南需要一个有效的分类。专门为儿童设计的分类方法已经存在，但考虑到儿童骨折在普通骨科科室中的相对罕见性，这些分类可能会导致准确性降低。我们测试了 Müller 分类法在儿童长骨骨折中的可靠性和准确性。
我们纳入了 2008 年在斯塔万格大学医院外科病房接受治疗的所有年龄<16 岁的儿童长骨骨折患者。20 名外科医生记录了 232 例骨折。为了进行内部和外部评估以及准确性计算，我们生成了数据集。我们展示了比例一致性（PA）和kappa（K）统计数据。
对于内部评估，总体一致性（κ）为 0.75（95%CI：0.68-0.81），PA 为 79%。对于外部评估，K 为 0.71（95%CI：0.61-0.80），PA 为 77%。准确性估计为：κ=0.72（95%CI：0.64-0.79），PA=76%。
当应用于儿童长骨骨折时，Müller 分类法（针对儿科骨折进行了轻微调整）在普通骨科外科医生中显示出了较高的准确性。然而，在评估骨折的治疗和预后时，必须考虑到儿童特有的骨折模式、骨骼的成熟度和移位程度等单独的知识。
