Methods:

Retrospective study consisting of concurrent, blind and independent assessments of a consecutive sample of 42 elbow X-rays (AP and lateral) of pediatric patients with supracondylar fractures. Three observers, with similar degree of training, evaluated the X-rays independently and scored each one of them using the 3 scales compared herein. The interobserver agreement was assessed using Kendall's Tau-b ratio; the arithmetic mean was calculated and the ratios were compared with Fisher's transformation. The interpretation was made using the standards proposed by Landis Koch.

Results:

The Holmberg and Gartland classifications had a mean correlation coefficient of 0.654 and 0.706, respectively (p < 0.001). Holmberg's classification provides a better anatomical description. The mean correlation coefficient of the AO classification was 0.491 (p = 0.001).The difference between the correlation coefficients was 0.052 for Holmbert/Gartland; 0.163 for Holmberg/AO, and 0.215 for Gartland/AO. There were no statistically significant differences among these values, but there were epistemological differences. According to Landis and Koch, the Holmberg and Gartland classifications show a substantial agreement, while the AO classification showed a moderate agreement.

Conclusion:

Holmberg's classification is the most recommendable one.