The reliability of a simplified Garden classification for intracapsular hip fractures - 02/06/12

Doi : 10.1016/j.otsr.2012.02.003

D. Van Embden ^a,^⁎ , S.J. Rhemrev ^a, F. Genelin ^b, S.A.G. Meylaerts ^a, G.R. Roukema ^c
^a Department of Surgery, Medisch Centrum Haaglanden, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
^b Unfallchirurgie, Kardinal Schwarzenberg’sches Krankenhaus, Kardinal Schwarzenbergstrasse 2-6, Schwarzach, Austria
^c Department of Surgery, Maasstad Ziekenhuis, Groene Hilledijk 315, 3075 EA, Rotterdam, The Netherlands

Corresponding author. Medisch Centrum Haaglanden, Lijnbaan 32, 2512 VA Den Haag, Postbus 432, 2501 CK Den Haag, The Netherlands, Tel.: +31703574444.

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Summary

Background

The Garden classification is used to classify intracapsular proximal femur fractures. The reliability of this classification is poor and several authors advise a simplified classification of intracapsular hip fractures into non-displaced and displaced fractures. However, this proposed simplified classification has never been tested for its reliability.

Hypothesis

We estimate simplifying the classification of femoral neck fractures will lead to a higher inter-observer agreement.

Materials and methods

Ten observers, trauma surgeons and residents, from two different institutes classified 100 intracapsular femoral neck fractures. The inter-observer agreements were calculated using the multi-rater Fleiss’ kappa.

Results

The inter-observer kappa for the Garden classification was 0.31. An agreement of κ0.52 was observed if the Garden classification was simplified and the fractures were classified by our observers as ‘non-displaced’ or ‘displaced’. No difference in reliability was seen for the use of the four-grade Garden classification as well as the simplified classification between trauma surgeons and residents.

Discussion

Classification of intracapsular hip fractures according to the four-grade Garden classification is unreliable. The reliability of classification improves when the Garden classification is simplified in a classification using the terms: ‘non-displaced’ or ‘displaced’.