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The Interrater and Intrarater Agreement of a Modified Neer Classification System and Associated Treatment Choice for Lateral Clavicle Fractures

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Author(s)
Chul-Hyun ChoJoo Han OhGu-Hee JungGi-Hyuk MoonIn Hyeok RhyouJong Pil YoonHo Min Lee
Keimyung Author(s)
Cho, Chul Hyun
Department
Dept. of Orthopedic Surgery (정형외과학)
Journal Title
American Journal of Sports Medicine
Issued Date
2015
Volume
43
Issue
10
Keyword
Lateral clavicleFractureNeer-Craig classificationTreatmentAgreementInterraterIntrarater
Abstract
Background: As there is substantial variation in the classification and diagnosis of lateral clavicle fractures, proper management
can be challenging. Although the Neer classification system modified by Craig has been widely used, no study has assessed its
validity through inter- and intrarater agreement.
Purpose: To determine the inter- and intrarater agreement of the modified Neer classification system and associated treatment
choice for lateral clavicle fractures and to assess whether 3-dimensional computed tomography (3D CT) improves the level of
agreement.
Study Design: Cohort study (diagnosis); Level of evidence, 3.
Methods: Nine experienced shoulder specialists and 9 orthopaedic fellows evaluated 52 patients with lateral clavicle fractures,
completing fracture typing according to the modified Neer classification system and selecting a treatment choice for each case.
Web-based assessment was performed using plain radiographs only, followed by the addition of 3D CT images 2 weeks later.
This procedure was repeated 4 weeks later. Fleiss k values were calculated to estimate the inter- and intrarater agreement.
Results: Based on plain radiographs only, the inter- and intrarater agreement of the modified Neer classification system was
regarded as fair (k = 0.344) and moderate (k = 0.496), respectively; the inter- and intrarater agreement of treatment choice
was both regarded as moderate (k = 0.465 and 0.555, respectively). Based on the plain radiographs and 3D CT images, the interand
intrarater agreement of the classification system was regarded as fair (k = 0.317) and moderate (k = 0.508), respectively; the
inter- and intrarater agreement of treatment choice was regarded as moderate (k = 0.463) and substantial (k = 0.623), respectively.
There were no significant differences in the level of agreement between the plain radiographs only and plain radiographs
plus 3D CT images for any k values (all P . .05).
Conclusion: The level of interrater agreement of the modified Neer classification system for lateral clavicle fractures was fair.
Additional 3D CT did not improve the overall level of interrater or intrarater agreement of the modified Neer classification system
or associated treatment choice. To eliminate a common source of disagreement among surgeons, a new classification system to
focus on unclassifiable fracture types is needed.
Keimyung Author(s)(Kor)
조철현
Publisher
School of Medicine
Citation
Chul-Hyun Cho et al. (2015). The Interrater and Intrarater Agreement of a Modified Neer Classification System and Associated Treatment Choice for Lateral Clavicle Fractures. American Journal of Sports Medicine, 43(10), 2431–2436. doi: 10.1177/0363546515593949
Type
Article
ISSN
0363-5465
Source
http://journals.sagepub.com.proxy.dsmc.or.kr/doi/abs/10.1177/0363546515593949?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
DOI
10.1177/0363546515593949
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/33061
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학)
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