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Scapula Fractures: Interobserver Reliability of Classification and Treatment

Neuhaus, Valentin MD; Bot, Arjan G. J. MD; Guitton, Thierry G. MD, PhD; Ring, David C. MD, PhD

Journal of Orthopaedic Trauma: March 2014 - Volume 28 - Issue 3 - p 124–129
doi: 10.1097/BOT.0b013e31829673e2
Original Article

Objectives: There is substantial variation in the classification and management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO classification and the New International Classification for Scapula Fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment.

Design: Web-based reliability study.

Setting: Independent orthopaedic surgeons from several countries were invited to classify scapular fractures in an online survey.

Participants: One hundred three orthopaedic surgeons evaluated 35 movies of three-dimensional computerized tomography reconstruction of selected scapular fractures, representing a full spectrum of fracture patterns.

Main Outcome Measurements: Fleiss kappa (κ) was used to assess the reliability of agreement between the surgeons.

Results: The overall agreement on the OTA/AO classification was moderate for the types (A, B, and C, κ = 0.54) with a 71% proportion of rater agreement (PA) and for the 9 groups (A1 to C3, κ = 0.47) with a 57% PA. For the New International Classification, the agreement about the intraarticular extension of the fracture (Fossa (F), κ = 0.79) was substantial and the agreement about a fractured body (Body (B), κ = 0.57) or process was moderate (Process (P), κ = 0.53); however, PAs were more than 81%. The agreement on the treatment recommendation was moderate (κ = 0.57) with a 73% PA.

Conclusions: The New International Classification was more reliable. Body and process fractures generated more disagreement than intraarticular fractures and need further clear definitions.

Orthopaedic Hand Service, Massachusetts General Hospital, Boston, MA.

Reprints: David C. Ring, MD, PhD, Orthopaedic Hand Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (e-mail:

No funding was received in direct support of this study. No authors have any connections to either of the classification systems.

V. Neuhaus has received a grant from the Bangerter Foundation Switzerland. A.G. J. Bot has received grants from VSB fonds, Beurs Prins Bernhard Cultuur fonds, beurs/Banning-de Jong fonds, Stichting Anna fonds, the Netherlands. T. G. Guitton had no conflicts of interest. D. C. Ring has no conflicts related to this research.

Accepted April 10, 2013

© 2014 by Lippincott Williams & Wilkins