ABSTRACT
Fracture-classification systems are used to recommend treatment and predict outcomes. In this study, a modified Gartland classification system of supracondylar humerus fractures in children was assessed for intraobserver and interobserver variability. Five observers classified radiographs of 50 consecutive children with extension supracondylar humerus fractures on three separate occasions. After a 2-week interval, 90% of fractures were classified the same on both readings, with and intraobserver kappa value of 0.84. After a 36-week interval, 89% of the fractures were classified the same, with a kappa value of 0.81. Interobserver reliability was evaluated by pairwise comparison among observers, resulting in an overall kappa value of 0.74. The reliability of the Gartland classification for supracondylar humerus fractures in children is better than that published for other fracture-classification systems. However, 10% of the time, a second reading by the same observer is different. This makes treatment recommendations based only on fracture type imprecise.
Subject(s)
Humeral Fractures/classification , Child , Diagnosis, Differential , Humans , Humeral Fractures/diagnostic imaging , Observer Variation , Radiography , Reproducibility of ResultsABSTRACT
This study reviews all open fractures treated at a tertiary children's hospital from 1990 to 1995 to determine whether delaying surgical debridement influences the rate of infection in the pediatric population. One hundred four open fractures were followed until both clinical and radiographic union was evident. A 1.0% rate of infection requiring surgical drainage, and a 1.0% rate of soft-tissue infection managed with oral antibiotics alone was found. Infection rates for fractures treated within 6 h of injury was 2.5%, and for fractures treated with >6 h delay was 1.6%. No significant statistical difference in infection rate with delay in surgical debridement was found (p = 0.77). Delays of 5 and 16 h were found in the two fractures complicated by infection, compared with an average delay of 12 h for those that healed uneventfully. Our findings suggest that in children given early parenteral antibiotics, operative irrigation and debridement may be delayed >6 h without an increased risk of infection. As this series contains only 18 patients with grade III open fractures and nine patients whose surgery was delayed >24 h, conclusions should not be made in these groups.
