Classification of long bone fractures in children

Classifi cation systems have been introduced for a variety of orthopedic conditions over the years, and for many of them—including fractures—several systems have been suggested. More comprehensive classifi cation systems are useful for pooling of data from publications over time, to compare data in different publications. Also, systematic reviews would benefi t greatly from a uniformity in terminology. Few classi-fi cation systems have emerged from systematic development, evaluation, validation, and implementation. It would seem important to involve professional societies and journals to persuade researchers to use validated classifi cation systems when reporting outcomes. In their systematic review regarding the reliability of reliability studies of fracture classifi cations, Audigé et al. (2004) concluded that most studies found that fracture classifi cations were not generally reliable in terms of observer agreement and accuracy. Furthermore, most reliability studies were heterogeneous in their approach and methods of evaluation, and were therefore not without fl aws. The authors stated that " the development and adoption of a systematic methodological approach for the development and validation of fracture clas-sifi cations is needed ". Audigé et al. (2005) went on to suggest an approach to future development and validation of classifi cation systems in orthopedics. A 3-phase system was proposed: • Phase 1: Development of the classifi cation system (or revision of an existing system) by clinical experts often involving several classifi cation-modifying iterations, and evaluation of reliability (inter-and intra-rater reproducibility) and accuracy. • Phase 2: Multicenter agreement studies in clinical practice , involving a large number of cases and numerous raters representing multiple levels of expertise. At the end of this phase, investigators should be able to agree that the system is acceptable; otherwise further modifi cations will be needed. • Phase 3: A prospective clinical observational phase, conducted to assess the clinical relevance and usefulness in terms of prognosis and treatment. This phase should ideally include several prospective clinical studies to corroborate the robustness of the system. The fi rst comprehensive fracture classifi cation system was published in 1990 by the AO group, and was merged with the Orthopaedic Trauma Association (OTA) classifi cation and developed further (Marsh et al. 2007). It was hoped that the classifi cation would lead to better patient care and encourage clinical research. Building on this work, an international AO workgroup led by Theddy Slongo developed the fracture classifi cation system for long bone fractures in children, and published their …