title: Development and validation of a paediatric long-bone fracture classification. A prospective multicentre study in 13 European paediatric trauma centres.
abstract: BACKGROUND
  The aim of this study was to develop a child-specific classification system for long bone fractures and to examine its reliability and validity on the basis of a prospective multicentre study.
  
  
  METHODS
  Using the sequentially developed classification system, three samples of between 30 and 185 paediatric limb fractures from a pool of 2308 fractures documented in two multicenter studies were analysed in a blinded fashion by eight orthopaedic surgeons, on a total of 5 occasions. Intra- and interobserver reliability and accuracy were calculated.
  
  
  RESULTS
  The reliability improved with successive simplification of the classification. The final version resulted in an overall interobserver agreement of κ = 0.71 with no significant difference between experienced and less experienced raters.
  
  
  CONCLUSIONS
  In conclusion, the evaluation of the newly proposed classification system resulted in a reliable and routinely applicable system, for which training in its proper use may further improve the reliability. It can be recommended as a useful tool for clinical practice and offers the option for developing treatment recommendations and outcome predictions in the future.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the JW Goethe-University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
authors.forename: Dorien
authors.initials: D
authors.lastname: Schneidmüller
authors.forename: Christoph
authors.initials: C
authors.lastname: Röder
authors.forename: Ralf
authors.initials: R
authors.lastname: Kraus
authors.forename: Ingo
authors.initials: I
authors.lastname: Marzi
authors.forename: Martin
authors.initials: M
authors.lastname: Kaiser
authors.forename: Daniel
authors.initials: D
authors.lastname: Dietrich
authors.forename: Lutz
authors.initials: L
authors.lastname: von Laer
mesh_terms: D000367:Age Factors; D001846:Bone Development / Q000502:physiology; D002648:Child; D005121:Extremities / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D005260:Female; D005544:Forecasting; D050723:Fractures, Bone / Q000145:classification* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D038801:International Classification of Diseases / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index