Fiabilité d’une classification de Garden simplifiée pour les fractures intracapsulaires du col fémoral

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’. Level of evidence Level IV. Diagnostic retrospective study.