Inter- and intra-observer agreement of the Milch and Weiss classification systems in pediatric fractures of the lateral humeral condyle



Objective. The aim of this study is to estimate the inter- and intra-observer agreement of the Weiss and Milch classification systems in radiological studies of fractures of the lateral humeral condyle in pediatric patients. Methods. An agreement study was performed with non-probability sampling of consecutive cases with a sample size of a hundred radiological studies, which were evaluated by three experienced orthopedic surgeons and three resident physicians; following a thorough comparison of both inter- and intra-observer agreements during six weeks based on the Fleiss' kappa index, which was used to determine the inter- and intra-observer agreement rates of both classifications. Results: The overall reliability of the entire group of evaluators for the Milch classification in the inter-observer evaluation was κ = 0.13, 95% CI 0.08−0.18, and the intra-observer evaluation was κ = 0.08, 95% CI 0.06−0.11. As for the Weiss classification, the overall evaluation had an inter-observer agreement of κ = 0.53, 95% CI 0.50−0.57, and an intra-observer agreement of κ = 0.22, 95% CI 0.20−0.24. Conclusions: In the present study, the Weiss classification system demonstrated greater agreement than the Milch classification; however, the latter may require the use of complementary studies such as an arthrography to enhance classification accuracy. Level of Evidence II, Diagnostic Studies – Investigating Diagnostic Examination.
Key words: Pediatric, lateral condyle fractures, agreement study, kappa index.

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