Cho Chul-Hyun, Kim Beom-Soo, Kim Du-Han, Choi Chang-Hyuk, Dan Jinmyoung, Lee HoMin
Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, South Korea.
Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, South Korea.
Orthop Traumatol Surg Res. 2018 Dec;104(8):1231-1235. doi: 10.1016/j.otsr.2018.05.015. Epub 2018 Nov 2.
Existing various classification systems for distal clavicle fractures have low interobserver and intraobserver reliability and provide limited information for treatment decision. The objective of this study was to determine interobserver and intraobserver reliability of the new classification system and the associated treatment choice for distal clavicle fractures.
The new classification system has good reliability.
Eight observers including 4 experienced shoulder specialists and 4 orthopedic fellows independently reviewed routine plain radiographs of 74 patients with distal clavicle fractures. They were asked to determine the fracture type according to the new classification system and the treatment choice for each case through web-based survey. Images from each case were randomly presented to the observers in 2 rounds 4 weeks apart. Reliability was assessed on the basis of Fleiss κ values.
Interobserver and intraobserver reliability of the classification system were moderate (κ=0.434) and substantial (κ=0.644), respectively. Interobserver and intraobserver reliability of the treatment choice were moderate (κ=0.593) and substantial (κ=0.698), respectively. There were no significant differences in the level of reliability between experienced shoulder specialists and orthopedic fellows for any κ values (all p>0.05).
Our study demonstrated moderate interobserver and substantial intraobserver reliability of the new classification system and the associated treatment choice for distal clavicle fractures. We believe that our novel classification system will help physicians to choose treatment and implants.
III, Cohort study, Diagnosis study.
现有的各种锁骨远端骨折分类系统在观察者间和观察者内的可靠性较低,且为治疗决策提供的信息有限。本研究的目的是确定新分类系统在观察者间和观察者内的可靠性以及锁骨远端骨折的相关治疗选择。
新分类系统具有良好的可靠性。
八名观察者,包括4名经验丰富的肩部专科医生和4名骨科住院医师,独立回顾了74例锁骨远端骨折患者的常规X线平片。通过基于网络的调查,要求他们根据新分类系统确定骨折类型并为每个病例选择治疗方案。每个病例的图像在相隔4周的两轮中随机呈现给观察者。根据Fleiss κ值评估可靠性。
分类系统的观察者间可靠性为中等(κ=0.434),观察者内可靠性为高度(κ=0.644)。治疗选择的观察者间可靠性为中等(κ=0.593),观察者内可靠性为高度(κ=0.698)。对于任何κ值,经验丰富的肩部专科医生和骨科住院医师之间的可靠性水平均无显著差异(所有p>0.05)。
我们的研究表明,新分类系统以及锁骨远端骨折的相关治疗选择在观察者间具有中等可靠性,在观察者内具有高度可靠性。我们相信,我们的新型分类系统将有助于医生选择治疗方法和植入物。
III,队列研究,诊断研究。