Determining fracture pattern stability more reliable for distal clavicle fracture classification
By Casey Tingle
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.
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.
