Does the Modified Gartland Classification Clarify Decision Making?

Leung, Sophia; Paryavi, Ebrahim; Herman, Martin J.; Sponseller, Paul D.; Abzug, Joshua M.

doi:10.1097/bpo.0000000000000741

Cited by 41 publications

(37 citation statements)

References 18 publications

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“…For example the kappa value for tibial plateau fractures classifications was 0.476 based on Schatzker classification [17]. Similarly the kappa for pediatric supracondylar fractures is reported at 0.475 for Wilkinsmodified Gartland classification [18]. Our intraobserver reliability for the 3D classification and axial classification were at κ = 0.61 and 0.80 respectively suggesting an acceptable range for clinical applications.…”

Section: Discussionsupporting

confidence: 58%

Three-dimensional classification of the Lenke 1 adolescent idiopathic scoliosis using coronal and lateral spinal radiographs

Pasha

Ho-Fung

Eker

et al. 2020

BMC Musculoskelet Disord

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Background Classification of the spinal deformity in adolescent idiopathic scoliosis (AIS) remains two-dimensional (2D) as the spinal radiographs remain the mainstay in clinical evaluation of the disease. 3D classification systems are proposed, however are time consuming. We here aim to evaluate the clinical application of a 3D classification system by the use of only posterior-anterior and lateral radiographs in Lenke 1 adolescent idiopathic scoliosis (AIS). Methods Forty Lenke 1 AIS were classified by five observers following a three-step flowchart, developed based on our previous 3D classification system. This 3D classification characterizes the curve in the frontal and sagittal views and infers the third dimension with rules based on prior data to determine the 3D subtypes of the curve. Repeated rating was performed for 20 randomly selected patients in the same cohort. In addition to the classification by the raters, the 3D model of the spines were generated to determine the actual curve subtype based on the algorithm that was originally used to develop the 3D classification system. The interobserver and intraobserver reliability and the classification accuracy were determined for both 3D and axial classifications of the cohort. Results The interobserver reliability was moderate to strong with a kappa value between 0.61–0.89 for 3D and axial classifications. Comparing the mathematical classification and the raters’ classification, the classification accuracy among all raters ranged between 56 and 89%. Conclusion We evaluated the reliability of a previously developed 3D classification system for Lenke 1 AIS patients when only two-view spinal radiographs are available. Radiologists and orthopedic surgeons were able to identify the 3D subtypes of Lenke 1 AIS from the patients’ radiographs with moderate to strong reliability. The new 3D classification has the potential to identify the subtypes of the Lenke 1 AIS without a need for quantitative 3D image post-processing.

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Section: Discussionsupporting

confidence: 58%

Three-dimensional classification of the Lenke 1 adolescent idiopathic scoliosis using coronal and lateral spinal radiographs

Pasha

Ho-Fung

Eker

et al. 2020

BMC Musculoskelet Disord

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“…In our study no statistically significant differences emerged concerning clinical examination and Flynn criteria and functional scores reported widely satisfactory results in both groups. Parameters that should be focused are probably two: complications (2 cases of cubitus varus in group A versus one superificial pin-tract infections in group B) and the better trend in surgical group in regards to loss of flexion and hyperextension of the affected elbow, likely related to the other notable 44 initially seemed to solve this problem, but then some intra-and inter-observer agreement troubles arose 14,15 and furthermore, as said, there is no mention of 2A and 2B distinction neither in AAOS guidelines nor in AUC. Aronson and Prager 45 proposed a distinction based on BA values (more or less than 5°compared to the unaffected side); in another paper Kao et al 21 gave a lot of importance to the AHL, which should bisect the capitellum in patients elder than 2.5 years 46 : if this happens there should be less probability of developing elbow hyperextension and flexion limitations (and our study outcomes seems to be in agreement with this).…”

Section: Discussionmentioning

confidence: 99%

“…11,13 It has furthermore been reported how operating on all type 2 fractures could result in more than 70% of unnecessary surgery, suggesting that conservative treatment should be adopted at least as first line of therapy. 13 Wilkins modification has been often used to try to solve this dilemma, addressing type 2A to casting and type 2B to surgery; but many doubts about the validity of this distinction have emerged, and several authors report low rates of intra-and inter-observer agreement in distinguishing 2A and 2B 14,15 ; moreover, in Appropriate Use Criteria (AUC) published by American Academy of Orthopaedic Surgeons (AAOS) in 2015, 16 there is no mention of this distinction.…”

Section: Introductionmentioning

confidence: 99%

Conservative versus surgical treatment of Gartland type 2 supracondylar humeral fractures: What can help us choosing?

Iorio

Crostelli

Mazza

et al. 2019

Journal of Orthopaedics

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Background: Pediatric supracondylar humeral fractures (PSHF) are most common elbow fractures among children and adolescents. While there is substantial agreement on treating type 1 and type 3 fractures (conservatively and surgically, respectively), the debate on optimal treatment of Gartland type 2 fractures is still open. We wanted to review our cases, analyzing outcomes and seeking for parameters that could help surgeons treating these injuries. Methods: We retrospectively reviewed 41 patients treated with reduction and casting (group A) and matched to 38 patients treated with closed reduction and percutaneous pining (CRPP, group B) for Gartland type 2 fractures between 2009 and 2013. At a mean follow-up of more than 6 years patients were analyzed by an accurate clinical exam and evaluation scales. Radiographic parameters at time of cast or pins removal were studied too. Results: There were no statistically significant differences in clinical exam and evaluation scales between groups. Two patients in group A developed a cubitus varus deformity and one patient in group B had a superficial pintract infection. Baumann angle (BA) was out of normal range in two cases of conservative group and anterior humeral line (AHL) bisected capitellum in 42.1% of patients in group A and 73.2% in group B (p < .05). Conclusion: It is reasonable to expect satisfactory outcomes both after conservative and surgical treatment of type 2 fractures, if cornerstones of both treatments are applied. Parameters that should be focused are probably two: complications (2 cases of cubitus varus in group A versus one superificial pin-tract infections in group B) and the better trend in surgical group in regards to loss of flexion and hyperextension of the affected elbow, likely related to the other notable datum, that is the percentage of cases in which AHL bisects capitellum. We think that, in absence of vascolonervous lesions and important swelling, BA and AHL are the most important parameters that can help us choosing the optimal treatment, as clarified in the algorithm we developed. Level of evidence: Level IIIretrospective comparative study.

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“…However, this sub-classification of type II fractures does not show a good intra- and inter-observer reliability. 19…”

Section: Classificationmentioning

confidence: 99%

Management of supracondylar fractures of the humerus in children

2018

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Supracondylar fractures of the humerus are the most frequent fractures of the paediatric elbow, with a peak incidence at the ages of five to eight years.Extension-type fractures represent 97% to 99% of cases. Posteromedial displacement of the distal fragment is the most frequent; however, the radial and median nerves are equally affected. Flexion-type fractures are more commonly associated with ulnar nerve injuries.Concomitant upper-limb fractures should always be excluded. To manage the vascular status, distal pulse and hand perfusion should be monitored. Compartment syndrome should always be borne in mind, especially when skin puckering, severe ecchymosis/swelling, vascular alterations or concomitant forearm fractures are present.Gartland’s classification shows high intra- and inter-observer reliability. Type I is treated with casting. Surgical treatment is the standard for almost all displaced fractures. Type IV fractures can only be diagnosed intra-operatively.Closed reduction and percutaneous pinning is the gold standard surgical treatment. Open reduction via the anterior approach is indicated for open fractures, absence of the distal vascular flow for > 10 to 15 minutes after closed reduction, and failed closed reduction.Lateral entry pins provide stable fixation, avoiding the risk of iatrogenic ulnar nerve injury.About 10% to 20% of displaced supracondylar fractures present with alterations in vascular status. In most cases, fracture reduction restores perfusion.Neural injuries occur in 6.5% to 19% of cases involving displaced fractures. Most of them are neurapraxias and it is not routinely indicated to explore the nerve surgically.Cite this article: EFORT Open Rev 2018;3:526-540. DOI: 10.1302/2058-5241.3.170049

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Does the Modified Gartland Classification Clarify Decision Making?

Abstract: Level III-diagnostic studies.

Cited by 41 publications

References 18 publications

Three-dimensional classification of the Lenke 1 adolescent idiopathic scoliosis using coronal and lateral spinal radiographs

Three-dimensional classification of the Lenke 1 adolescent idiopathic scoliosis using coronal and lateral spinal radiographs

Conservative versus surgical treatment of Gartland type 2 supracondylar humeral fractures: What can help us choosing?

Management of supracondylar fractures of the humerus in children

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