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Determining fracture pattern stability more reliable for distal clavicle fracture classification
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For the classification of distal clavicle fractures, researchers found the determination of fracture pattern stability may be a more appropriate and reliable method compared with distal fragment size and Neer classification.
Fourteen shoulder/sports medicine fellowship-trained orthopedic surgeons evaluated 30 radiographs of patients treated for distal clavicle fracture between 2006 and 2011. The researchers asked the evaluators to measure the size of the distal fragment, classify the fracture pattern as stable or unstable, assign the Neer classification and recommend operative vs. nonoperative treatment. The researchers reordered and redistributed the radiographs 3 months later, and inter- and intrarater agreement was determined for the distal fragment size, stability of the fracture, Neer classification and decision to operate.
Julie Bishop
Results showed interrater agreement for increased distal fragment size was substantial for fragments greater than 50 mm, moderate for fragments 30 mm to 40 mm, and fair or slight for other sizes. The researchers found moderate interrater agreement demonstrated by stability and on indications for surgical treatment. Although Neer classification was fair overall, slight agreement was found on Neer IIB fractures.
According to study results, fracture size categories and the Neer classification had moderate intrarater agreement, and determination of fracture stability and the decision to operate had substantial intrarater agreement.
Compared with looking at stability alone, results showed the prediction or recommendation of surgery for the distal clavicle fracture did not significantly improve when the size of the distal clavicle fracture fragment or the Neer classification was added. The receiver operating characteristic curve showed a significantly higher area for the model containing stability vs. the model containing classification and fracture fragment size.
Overall, the researchers found fracture pattern stability had an 89% accuracy when predicting the decision to operate. – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.
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