Department of Biostatistics, Marmara University School of Medicine.
Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine.
J Pediatr Orthop B. 2024 Mar 1;33(2):142-146. doi: 10.1097/BPB.0000000000001094. Epub 2023 May 22.
The Gartland classification is used to decide on surgery. In contrast, the John Hopkins classification system predicts clinical outcomes for patients undergoing surgery and determines the risk of reduction loss. This study aims to investigate the usability of the Gartland and the John Hopkins classification systems by pediatric and general orthopedic surgeons. The preoperative images of 200 patients who presented at a tertiary-level trauma center with a supracondylar humerus fracture were examined by 4 observers, twice at an interval of 6 weeks. The observers comprised 2 pediatric orthopedic surgeons and 2 orthopedics and traumatology surgeons. Inter- and intra-observer reliability were excellent for the first and second measurements of the Gartland classification. The inter-observer agreement of the pediatric orthopedic surgeons and the general orthopedic surgeons was found to be similar (ICC >90). Inter-observer reliability was excellent (ICC: 0.808) and good (ICC: 0.732) for the measurements of the John Hopkins classification, respectively. The inter-observer agreement of the pediatric orthopedic surgeons and the general orthopedic surgeons was not similar. The inter-observer agreement between the two pediatric orthopedic surgeons was excellent for the measurements (ICC: 0.868; ICC: 0.756, respectively). The inter-observer agreement between the two general orthopedic surgeons was good for the measurements (ICC: 0.605; ICC: 0.663, respectively). The John Hopkins classification system has good intra- and inter-observer reliability, and a high experience level increases the agreement. The Gartland classification system was not affected by experience. This should be considered when taking measurements in studies and patient management.
Gartland 分类法用于决定是否手术。相比之下，约翰霍普金斯分类系统预测接受手术的患者的临床结果，并确定复位丢失的风险。本研究旨在调查小儿骨科医生和普通骨科医生对 Gartland 和约翰霍普金斯分类系统的可用性。对在三级创伤中心就诊的 200 名肱骨髁上骨折患者的术前图像，由 4 名观察者，在 6 周间隔内进行了两次检查。观察者包括 2 名小儿骨科医生和 2 名骨科和创伤外科医生。Gartland 分类的第一次和第二次测量的观察者内和观察者间可靠性均为极好。小儿骨科医生和普通骨科医生的观察者间一致性被发现相似（ICC＞90）。约翰霍普金斯分类的测量的观察者间可靠性极好（ICC：0.808）和良好（ICC：0.732）。小儿骨科医生和普通骨科医生的观察者间一致性不相似。两位小儿骨科医生的测量的观察者间一致性极好（ICC：0.868；ICC：0.756）。两位普通骨科医生的测量的观察者间一致性良好（ICC：0.605；ICC：0.663）。约翰霍普金斯分类系统具有良好的观察者内和观察者间可靠性，经验水平的提高增加了一致性。Gartland 分类系统不受经验影响。在研究和患者管理中进行测量时应考虑这一点。
