title: The reliability of a simplified Garden classification for intracapsular hip fractures.
abstract: 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.
  
  
  OBJECTIVE
  We estimate simplifying the classification of femoral neck fractures will lead to a higher inter-observer agreement.
  
  
  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.
  
  
  CONCLUSIONS
  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'.
  
  
  METHODS
  Level IV. Diagnostic retrospective study.
authors.affiliation: Department of Surgery, Medisch Centrum Haaglanden, Lijnbaan 32, 2512 VA, The Hague, The Netherlands. daphnevanembden@hotmail.com
authors.forename: D
authors.initials: D
authors.lastname: Van Embden
authors.forename: S J
authors.initials: SJ
authors.lastname: Rhemrev
authors.forename: F
authors.initials: F
authors.lastname: Genelin
authors.forename: S A G
authors.initials: SA
authors.lastname: Meylaerts
authors.forename: G R
authors.initials: GR
authors.lastname: Roukema
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000145:classification* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies