Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter Study

作者全名："Lin, Jian; Sun, Wei-Jin; Chen, Jian-Hai; Dong, Jing-Ming; Bao, Ding-Su; Yan, Ling; Ni, Wei-Dong; Xiang, Ming; Ding, Jian; Cai, Ming; Song, Jia-Xiang; Mao, Ming-Gui; Wu, Xiao-Ming"

作者地址："[Lin, Jian; Sun, Wei-Jin; Wu, Xiao-Ming] Shanghai Jiao Tong Univ, Shanghai Gen Hosp, Dept Trauma Ctr, Shanghai, Peoples R China; [Ding, Jian] Shanghai Jiao Tong Univ, Peoples Hosp 6, Dept Orthoped, Shanghai, Peoples R China; [Cai, Ming] Tongji Univ, Shanghai Peoples Hosp 10, Dept Orthoped, Sch Med, Shanghai, Peoples R China; [Chen, Jian-Hai] Peking Univ Peoples Hosp, Dept Trauma & Orthoped, Beijing, Peoples R China; [Dong, Jing-Ming] Tianjin Hosp, Dept Upper Extrem Traumatol 2, Tianjin, Peoples R China; [Bao, Ding-Su] South West Med Univ, Affiliated Tradit Chinese Med Hosp, Dept Orthoped, Lu Zhou, Peoples R China; [Bao, Ding-Su] South West Med Univ, Affiliated Tradit Chinese Med Hosp, Ctr Orthoped Dis Res, Lu Zhou, Peoples R China; [Yan, Ling] First Peoples Hosp Zunyi City, Dept Orthoped, Zunyi, Peoples R China; [Song, Jia-Xiang] Wuchuan Tradit Chinese Med Hosp, Dept Orthoped, Zunyi, Peoples R China; [Mao, Ming-Gui] Sichuan Prov Orthpaed Hosp, Dept Orthoped, Zunyi, Peoples R China; [Ni, Wei-Dong] Chongqing Med Univ, Affiliated Hosp 1, Dept Orthoped, Chongqing, Peoples R China"

通信作者："Wu, XM (通讯作者)，Shanghai Jiao Tong Univ, Shanghai Gen Hosp, Dept Trauma Ctr, Shanghai, Peoples R China."

来源：ORTHOPAEDIC SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000923644800001

JCR分区：Q2

影响因子：1.8

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：Classification Systems; Interobserver Agreement; Lateral Clavicle Fracture

摘要："Objective Distal clavicle fracture classification directly affects the treatment decisions. It is unclear whether the classification systems implemented differ depending on surgeons' backgrounds. This study aimed to compare the interobserver agreement of four classification systems used for lateral clavicle fractures by shoulder specialists and general trauma surgeons.Methods Radiographs of 20 lateral clavicle fractures representing a full spectrum of adult fracture patterns were analyzed by eight experienced shoulder specialists and eight general trauma surgeons from 10 different hospitals. All cases were graded according to the Orthopedic Trauma Association (OTA), Neer, Jager/Breitner, and Gongji classification systems. To measure observer agreement, Fleiss' kappa coefficient (kappa) was applied and assessed.Results When only X-ray films were presented, both groups achieved fair agreement. However, when the 3D-CT scan images were provided, improved interobserver agreement was found in the specialist group when the OTA, Jager/Breitner, and Gongji classification systems were used. In the generalist groups, improved agreement was found when using the Gongji classification system. In terms of interobserver reliability, the OTA, Neer, and Jager/Breitner classification systems showed better agreement among shoulder specialists, while a slightly lower level of agreement was found using the Gongji classification system. For the OTA classification system, interobserver agreement had a mean kappa value of 0.418, ranging from 0.446 (specialist group) to 0.402 (generalist group). For the Neer classification system, interobserver agreement had a mean kappa value of 0.368, ranging from 0.402 (specialist group) to 0.390 (generalist group). For the Jager/Breitner classification system, the inter-observer agreement had a mean kappa value of 0.380, ranging from 0.413 (specialist group) to 0.404 (generalist group). For the Gongji classification system, interobserver agreement had a mean kappa value of 0.455, ranging from 0.480 (specialist group) to 0.485 (generalist group).Conclusion Generally speaking, 3D-CT scans provide a richer experience that can lead to better results in most classification systems of lateral clavicle fractures, highlighting the value of digitization and specialization in diagnosis and treatment. Competitive interobserver agreement was exhibited in the generalist group using the Gongji classification system, suggesting that the Gongji classification is suitable for general trauma surgeons who are not highly experienced in the shoulder field."

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