ArticlePatient safety in surgery2020
Inter- and intraobserver agreement of three classification systems for lateral clavicle fractures - reliability comparison between two specialist groups.
Article in Patient safety in surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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9 citing papers in PubMed.
- 3D printing improves preoperative decision making for patient positioning and surgical approach selection for tibial plateau fractures.Scientific reports · 2025Article
- A new classification system for distal clavicle fractures: based on fracture location and ligament integrity.Archives of orthopaedic and trauma surgery · 2024Article
- Coracoclavicular fixation techniques for Neer IIb and "extralateral" fractures of the distal clavicle: a systematic review.JSES reviews, reports, and techniques · 2024Review
- Reliability of the 2018 Revised Version of AO/OTA Classification for Femoral Shaft Fractures.Clinics in orthopedic surgery · 2024Article
- Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter Study.Orthopaedic surgery · 2023Article
- The influence of 3D printing on inter- and intrarater reliability on the classification of tibial plateau fractures.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Article
- Monopolar and Bipolar Combination Injuries of the Clavicle: Retrospective Incidence Analysis and Proposal of a New Classification System.Journal of clinical medicine · 2021Article
- The Management of Distal Clavicle Fractures - A Survey of UK Shoulder and Elbow Surgeons.Cureus · 2021Article
- Classifications in Brief: The Modified Neer Classification for Distal-third Clavicle Fractures.Clinical orthopaedics and related research · 2021Article
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7 authors.
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Abstract
backgroundAlthough of great value in the management of lateral clavicle fractures, substantial variation in their classification exists. We performed a retrospective study to address the inter- and intraobserver reliability of three different classification systems for lateral clavicle fractures.
methodsRadiographs of 20 lateral clavicle fractures that represented a full spectrum of adult fracture patterns were graded by five experienced radiologists and five experienced trauma surgeons according to the Orthopaedic Trauma Association (OTA), the Neer, and the Jäger/Breitner classification systems. This evaluation was performed at two different time points separated by 3 months. To measure the observer agreement, the Fleiss kappa coefficient (κ) was applied and assessed according to the grading of Landis and Koch.
resultsThe overall interobserver reliability showed a fair agreement in all three classification systems. For the OTA classification system, the interobserver agreement showed a mean kappa value of 0.338 ranging from 0.350 (radiologists) to 0.374 (trauma surgeons). Kappa values of the interobserver agreement for the Neer classification system ranged from 0.238 (trauma surgeons) to 0.276 (radiologists) with a mean κ of 0.278. The Jäger/Breitner classification system demonstrated a mean kappa value of 0.330 ranging from 0.306 (trauma surgeons) to 0.382 (radiologists).The overall intraobserver reliability was moderate for the OTA and the Jäger/Breitner classification systems, while the overall intraobserver reliability for the Neer classification system was fair.The kappa values of the intraobserver agreements showed, in all classification systems, a wide range with the OTA classification system ranging from 0.086 to 0.634, the Neer classification system ranging from 0.137 to 0.448, and a range from 0.154 to 0.625 of the Jäger/Breitner classification system.
conclusionsThe low inter- and intraobserver agreement levels exhibited in all three classification systems by both specialist groups suggest that the tested lateral clavicle fracture classification systems are unreliable and, therefore, of limited value. We should recognize there is considerable inconsistency in how physicians classify lateral clavicle fractures and therefore any conclusions based on these classifications should be recognized as being somewhat subjective.
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