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Scapula fractures: interobserver reliability of classification and treatment
journal contribution
posted on 2014-03-01, 00:00 authored by Valentin Neuhaus, Arjan G J Bot, Thierry G Guitton, David C Ring, Science of Variation Group, Mahmoud I Abdel-Ghany, Jeffrey Abrams, Joshua M Abzug, Lars E Adolfsson, George W Balfour, H Brent Bamberger, Antonio Barquet, Michael Baskies, W Arnold Batson, Taizoon Baxamusa, Grant J Bayne, Thierry Begue, Michael Behrman, Daphne Beingessner, Jan Biert, Julius Bishop, Mateus Borges Oliveira Alves, Martin Boyer, Drago Brilej, Peter R G Brink, Lance M Brunton, Richard Buckley, Juan Carlos Cagnone, Ryan P Calfee, Luiz Augusto B Campinhos, Charles Cassidy, Louis Catalano, Karel Chivers, Pradeep Choudhari, Matej Cimerman, Joseph M Conflitti, Ralph M Costanzo, Brett D Crist, Brian J Cross, Phani Dantuluri, Michael Darowish, Ramon de Bedout, Thomas DeCoster, David G Dennison, Peter H DeNoble, Gregory DeSilva, Thomas Dienstknecht, Scott F Duncan, Xavier A Duralde, Holger Durchholz, Kenneth Egol, Carl Ekholm, Nelson Elias, John M Erickson, J Daniel Espinosa Esparza, C H Fernandes, Thomas J Fischer, Martin Fischmeister, E Forigua Jaime, Charles L Getz, Richard S Gilbert, Vincenzo Giordano, David L Glaser, Taco Gosens, Michael W Grafe, Jose Eduardo Grandi Ribeiro Filho, Robert R L Gray, Lawrence V Gulotta, Nigel William Gummerson, Eric Mark Hammerberg, Edward Harvey, R Haverlag, Patrick D G Henry, Jonathan L Hobby, Eric P Hofmeister, Thomas Hughes, John Itamura, Peter Jebson, Richard Jenkinson, Kyle Jeray, Christopher M Jones, Jedediah Jones, Axel Jubel, Scott G Kaar, K Kabir, F Thomas D Kaplan, Stephen A Kennedy, Michael W Kessler, Hervey L Kimball, Peter Kloen, Cyrus Klostermann, Georges Kohut, G A Kraan, Anze Kristan, Mark I Loebenberg, Kevin J Malone, L Marsh, Paul A Martineau, John McAuliffe, Iain McGrawOBJECTIVES: There is substantial variation in the classification and management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO classification and the New International Classification for Scapula Fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment. DESIGN: Web-based reliability study. SETTING: Independent orthopaedic surgeons from several countries were invited to classify scapular fractures in an online survey. PARTICIPANTS: One hundred three orthopaedic surgeons evaluated 35 movies of three-dimensional computerized tomography reconstruction of selected scapular fractures, representing a full spectrum of fracture patterns. MAIN OUTCOME MEASUREMENTS: Fleiss kappa (κ) was used to assess the reliability of agreement between the surgeons. RESULTS: The overall agreement on the OTA/AO classification was moderate for the types (A, B, and C, κ = 0.54) with a 71% proportion of rater agreement (PA) and for the 9 groups (A1 to C3, κ = 0.47) with a 57% PA. For the New International Classification, the agreement about the intraarticular extension of the fracture (Fossa (F), κ = 0.79) was substantial and the agreement about a fractured body (Body (B), κ = 0.57) or process was moderate (Process (P), κ = 0.53); however, PAs were more than 81%. The agreement on the treatment recommendation was moderate (κ = 0.57) with a 73% PA. CONCLUSIONS: The New International Classification was more reliable. Body and process fractures generated more disagreement than intraarticular fractures and need further clear definitions.
