Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter Study
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 lat...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-08-01
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| Series: | Orthopaedic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/os.13659 |
| _version_ | 1828718023785054208 |
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| author | Jian Lin Wei‐Jin Sun Jian‐Hai Chen Jing‐Ming Dong Ding‐Su Bao Ling Yan Wei‐Dong Ni Ming Xiang Jian Ding Ming Cai Jia‐Xiang Song Ming‐Gui Mao Xiao‐Ming Wu |
| author_facet | Jian Lin Wei‐Jin Sun Jian‐Hai Chen Jing‐Ming Dong Ding‐Su Bao Ling Yan Wei‐Dong Ni Ming Xiang Jian Ding Ming Cai Jia‐Xiang Song Ming‐Gui Mao Xiao‐Ming Wu |
| author_sort | Jian Lin |
| collection | DOAJ |
| description | 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, Jäger/Breitner, and Gongji classification systems. To measure observer agreement, Fleiss' kappa coefficient (κ) 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, Jäger/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 Jäger/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 Jäger/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. |
| first_indexed | 2024-03-12T14:36:51Z |
| format | Article |
| id | doaj.art-0f9c79afcafb4150882a1eaed31a8f1b |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-03-12T14:36:51Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-0f9c79afcafb4150882a1eaed31a8f1b2023-08-17T03:22:41ZengWileyOrthopaedic Surgery1757-78531757-78612023-08-011582138214310.1111/os.13659Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter StudyJian Lin0Wei‐Jin Sun1Jian‐Hai Chen2Jing‐Ming Dong3Ding‐Su Bao4Ling Yan5Wei‐Dong Ni6Ming Xiang7Jian Ding8Ming Cai9Jia‐Xiang Song10Ming‐Gui Mao11Xiao‐Ming Wu12Department of Trauma Center Shanghai General Hospital affiliated to Shanghai Jiao Tong University Shanghai ChinaDepartment of Trauma Center Shanghai General Hospital affiliated to Shanghai Jiao Tong University Shanghai ChinaDepartment of Trauma & Orthopedics Peking University People's Hospital Beijing ChinaDepartment of Upper Extremity Traumatology No.2 Tianjin Hospital Tianjin ChinaDepartment of Orthopedics and Center for Orthopedic Diseases Research Affiliated Traditional Chinese Medicine Hospital of South‐West Medical University Lu Zhou ChinaDepartment of Orthopedics The First People's Hospital of Zunyi City Zunyi ChinaDepartment of Orthopedics The First Affiliated Hospital of Chongqing Medical University Chongqing ChinaDepartment of Upper Limb Sichuan Province Orthpaedic Hospital Chengdu ChinaDepartment of Orthopedics Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai ChinaDepartment of Orthopedics Shanghai Tenth People's Hospital, Tongji University School of Medicine Shanghai ChinaDepartment of Orthopedics Wuchuan Traditional Chinese Medicine Hospital Zunyi ChinaDepartment of Orthopedics Fenggang Traditional Chinese medicine hospital Zunyi ChinaDepartment of Trauma Center Shanghai General Hospital affiliated to Shanghai Jiao Tong University Shanghai ChinaObjective 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, Jäger/Breitner, and Gongji classification systems. To measure observer agreement, Fleiss' kappa coefficient (κ) 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, Jäger/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 Jäger/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 Jäger/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.https://doi.org/10.1111/os.13659Classification SystemsInterobserver AgreementLateral Clavicle Fracture |
| spellingShingle | Jian Lin Wei‐Jin Sun Jian‐Hai Chen Jing‐Ming Dong Ding‐Su Bao Ling Yan Wei‐Dong Ni Ming Xiang Jian Ding Ming Cai Jia‐Xiang Song Ming‐Gui Mao Xiao‐Ming Wu Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter Study Orthopaedic Surgery Classification Systems Interobserver Agreement Lateral Clavicle Fracture |
| title | Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter Study |
| title_full | Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter Study |
| title_fullStr | Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter Study |
| title_full_unstemmed | Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter Study |
| title_short | Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter Study |
| title_sort | comparison of interobserver agreement of four classification systems for lateral clavicle fractures between two groups of surgeons a multicenter study |
| topic | Classification Systems Interobserver Agreement Lateral Clavicle Fracture |
| url | https://doi.org/10.1111/os.13659 |
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