Classification of distal radius fractures in children: good inter- and intraobserver reliability, which improves with clinical experience

Per-Henrik Randsborg,Einar A Sivertsen

doi:10.1186/1471-2474-13-6

Abstract

BackgroundWe wanted to test the reliability of a commonly used classification of distal radius fractures in children.Methods105 consecutive fractures of the distal radius in children were rated on two occasions three months apart by 3 groups of doctors; 4 junior registrars, 4 senior registrars and 4 orthopedic consultants. The fractures were classified as buckle, greenstick, complete or physeal. Kappa statistics were used to analyze inter- and intraobserver reliability.ResultsThe kappa value for interobserver agreement at the first reading was 0.59 for the junior registrars, 0.63 for the senior registrars and 0.66 for the consultants. The mean kappa value for intraobserver reliability was 0.79 for the senior registrars, 0.74 for the consultants and 0.66 for the junior registrars.ConclusionsWe conclude that the classification tested in this study is reliable and reproducible when applied by raters experienced in fracture management. The reliability varies according to the experience of the raters. Experienced raters can verify the classification, and avoid unnecessary follow-up appointments.

Highlights

We wanted to test the reliability of a commonly used classification of distal radius fractures in children
Interobserver reliability The highest interobserver agreement at the first reading was achieved by the consultants, with a percentage of agreement of 67.6%, and a kappa value of 0.66 (Table 3)
The overall interobserver agreement among the 8 most experienced observers was 58.1% of the radiographs at the first reading, representing a kappa value of 0.66 (95% C.I: 0.64 - 0.68)

Summary

Introduction

We wanted to test the reliability of a commonly used classification of distal radius fractures in children. Distal radius fractures is the most common fracture in childhood [1]. Most of these fractures are treated conservatively in a plaster and complications are rare. These fractures generally are benign, they are monitored differently according to the stability of the fracture and whether the growth plate is injured or not. If an unstable fracture is classified in a benign category with little or no followup, it can lead to complications, i.e. malunion of the fracture.

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