Orthopaedic Hand Service, Massachusetts General Hospital, Boston, MA.
J Orthop Trauma. 2014 Mar;28(3):124-9. doi: 10.1097/BOT.0b013e31829673e2.
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.
Web-based reliability study.
Independent orthopaedic surgeons from several countries were invited to classify scapular fractures in an online survey.
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.
Fleiss kappa (κ) was used to assess the reliability of agreement between the surgeons.
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.
The New International Classification was more reliable. Body and process fractures generated more disagreement than intraarticular fractures and need further clear definitions.
肩胛骨骨折的分类和管理存在很大差异。本研究的首要目的是分析OTA/AO 分类和新国际肩胛骨骨折分类的观察者间可靠性。第二个目的是评估骨科医生在手术或非手术治疗方面的一致性比例。
基于网络的可靠性研究。
邀请来自多个国家的独立骨科医生在在线调查中对肩胛骨骨折进行分类。
103 名骨科医生评估了代表各种骨折模式的 35 个选定肩胛骨骨折三维计算机断层扫描重建的电影。
Fleiss kappa（κ）用于评估外科医生之间一致性的可靠性。
总体而言，OTA/AO 分类的类型（A、B 和 C）的一致性为中度（κ=0.54），评估者一致性（PA）为 71%，9 组（A1 至 C3）的一致性为中度（κ=0.47），PA 为 57%。对于新国际分类，骨折关节内延伸（Fossa（F））的一致性为显著（κ=0.79），骨折体（Body（B））或骨折过程（Process（P））的一致性为中度（κ=0.57）；然而，PA 超过 81%。治疗建议的一致性为中度（κ=0.57），PA 为 73%。
新国际分类更可靠。体部和骨折过程比关节内骨折产生更多的分歧，需要进一步明确定义。
