Objectives: 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.
Scapula fractures: Interobserver reliability of classification and treatment / Neuhaus, Valentin; Bot, Arjan G. J.; Guitton, Thierry G.; Ring, David C.; Abdel-Ghany, Mahmoud I.; Abrams, Jeffrey; Abzug, Joshua M.; Adolfsson, Lars E.; Balfour, George W.; Bamberger, H. Brent; Barquet, Antonio; Baskies, Michael; Batson, W. Arnold; Baxamusa, Taizoon; Bayne, Grant J.; Begue, Thierry; Behrman, Michael; Beingessner, Daphne; Biert, Jan; Bishop, Julius; Alves, Mateus Borges Oliveira; Boyer, Martin; Brilej, Drago; Brink, Peter R. G.; Brunton, Lance M.; Buckley, Richard; Cagnone, Juan Carlos; Calfee, Ryan P.; Campinhos, Luiz Augusto B.; Cassidy, Charles; Catalano, Louis; Chivers, Karel; Choudhari, Pradeep; Cimerman, Matej; Conflitti, Joseph M.; Costanzo, Ralph M.; Crist, Brett D.; Cross, Brian J.; Dantuluri, Phani; Darowish, Michael; De Bedout, Ramon; DeCoster, Thomas; Dennison, David G.; DeNoble, Peter H.; DeSilva, Gregory; Dienstknecht, Thomas; Duncan, Scott F.; Duralde, Xavier A.; Durchholz, Holger; Egol, Kenneth; Ekholm, Carl; Elias, Nelson; Erickson, John M.; Esparza, J. Daniel Espinosa; Fernandes, C. H.; Fischer, Thomas J.; Fischmeister, Martin; Jaime, Forigua E.; Getz, Charles L.; Gilbert, Richard S.; Giordano, Vincenzo; Glaser, David L.; Gosens, Taco; Grafe, Michael W.; Filho, Jose Eduardo Grandi Ribeiro; Gray, Robert R. L.; Gulotta, Lawrence V.; Gummerson, Nigel William; Hammerberg, Eric Mark; Harvey, Edward; Haverlag, R.; Henry, Patrick D. G.; Hobby, Jonathan L.; Hofmeister, Eric P.; Hughes, Thomas; Itamura, John; Jebson, Peter; Jenkinson, Richard; Jeray, Kyle; Jones, Christopher M.; Jones, Jedediah; Jubel, Axel; Kaar, Scott G.; Kabir, K.; Kaplan, F. Thomas D.; Kennedy, Stephen A.; Kessler, Michael W.; Kimball, Hervey L.; Kloen, Peter; Klostermann, Cyrus; Kohut, Georges; Kraan, G. A.; Kristan, Anze; Loebenberg, Mark I.; Malone, Kevin J.; Marsh, L.; Martineau, Paul A.; McAuliffe, John; McGraw, Iain; Mehta, Samir; Merchant, Milind; Metzger, Charles; Meylaerts, S. A.; Miller, Anna N.; Wolf, Jennifer Moriatis; Murachovsky, Joel; Murthi, Anand; Nancollas, Michael; Nolan, Betsy M.; Omara, Timothy; Omid, Reza; Ortiz, Jose A.; Overbeck, Joachim P.; Page, Richard S.; Castillo, Alberto Pérez; Pesantez, Rodrigo; Polatsch, Daniel; Porcellini, G.; Prayson, Michael; Quell, M.; Ragsdell, Matthew M.; Reid, James G.; Reuver, J. M.; Richard, Marc J.; Richardson, Martin; Rizzo, Marco; Rowinski, Sergio; Rubio, Jorge; Guerrero, Carlos G. Sánchez; Satora, Wojciech; Schandelmaier, Peter; Scheer, Johan H.; Schmidt, Andrew; Schubkegel, Todd A.; Schulte, Leah M.; Schumer, Evan D.; Sears, Benjamin W.; Shafritz, Adam B.; Shortt, Nicholas L.; Siff, Todd; Silva, Dario Mejia; Smith, Raymond Malcolm; Spruijt, Sander; Stein, Jason A.; Pemovska, Emilija Stojkovska; Streubel, Philipp N.; Swigart, Carrie; Swiontkowski, Marc; Thomas, George; Tolo, Eric T.; Turina, Matthias; Tyllianakis, Minos; Van Den Bekerom, Michel P. J.; Van Der Heide, Huub; Van De Sande, M. A. J.; Van Eerten, P. V.; Verbeek, DIederik O. F.; Hoffmann, David Victoria; Vochteloo, A. J. H.; Wagenmakers, Robert; Wall, Christopher J.; Wallensten, Richard; Wascher, Daniel C.; Weiss, Lawrence; Wiater, J. Michael; Wills, Brian P. D.; Wint, Jeffrey; Wright, Thomas; Young, Jason P.; Zalavras, Charalampos; Zura, Robert D.; Zyto, Karol. - In: JOURNAL OF ORTHOPAEDIC TRAUMA. - ISSN 0890-5339. - 28:3(2014), pp. 124-129. [10.1097/BOT.0b013e31829673e2]
Scapula fractures: Interobserver reliability of classification and treatment
Porcellini, G.;
2014
Abstract
Objectives: 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.
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