scapula fracture classification system - Kreiskrankenhaus Mechernich

More documents

Recommendations

Info

Classification of glenoid fractures 519 Table II Classification accuracy for patterns of simple fractures of glenoid fossa Surgeons and fracture categories Fracture classes 1 2 3 Class size 36% 19% 45% Surgeon 1 1: Anterior rim or oblique 85%) 34% 29% 2: Posterior rim or oblique 0% 64%) 0% 3: Transverse or short oblique 15% 2% 71%) Surgeon 2 1: Anterior rim or oblique 88%) 1% 1% 2: Posterior rim or oblique 1% 80%) 13% 3: Transverse or short oblique 11% 18% 87%) Surgeon 3 1: Anterior rim or oblique 91%) 2% 1% 2: Posterior rim or oblique 0% 96%) 6% 3: Transverse or short oblique 9% 3% 93%) Surgeon 4 1: Anterior rim or oblique 98%) 2% 9% 2: Posterior rim or oblique 0% 69%) 0% 3: Transverse or short oblique 2% 29% 91%) Surgeon 5 1: Anterior rim or oblique 98%) 18% 1% 2: Posterior rim or oblique 0% 64%) 6% 3: Transverse or short oblique 1% 18% 93%) Surgeon 6 1: Anterior rim or oblique 98%) 2% 19% 2: Posterior rim or oblique 1% 80%) 13% 3: Transverse or short oblique 1% 18% 68%) Surgeon 7 1: Anterior rim or oblique 91%) 2% 6% 2: Posterior rim or oblique 8% 96%) 0% 3: Transverse or short oblique 1% 2% 93%) Classification accuracies Minimum 85% 64% 68% Median 91% 80% 91% Maximum 98% 96% 93% ) Percentages indicate surgeon classification accuracies (percentages of correct classification). mainly focused on scapula body and neck fractures. Although they did not propose a classification system for glenoid fractures, they documented involvement of the glenoid in 17% of all scapula fractures. This incidence is surprisingly low considering the fact that these authors included fractures undergoing operative treatment. According to the current treatment decision process, 24 the fracture population of Armitage et al should have a bias toward including proportionally more glenoid fractures. On the other hand, Ada and Miller 1 reported glenoid fractures in 10% of their series based on assessments using plain radiographs. Such heterogeneity in the proportion of glenoid fractures may be a reflection that the distribution of fracture patterns is likely to differ between settings and, as such, a comparison between scapula fracture studies requires adequate classification and documentation. The combination of a glenoid fracture and scapula body fracture is frequent, so it is also important to have a combined classification considering both the glenoid and the rest of the scapula. This classification system should be descriptive and comprehensive, as well as aid in the decision-making process for individual therapy, especially if minimally invasive approaches are intended. 12 To our knowledge, the current scapula classification system is most comprehensive as well as highly reliable and accurate. Other existing scapula fracture classification systems lack a more focused description of glenoid fractures. The commonly used classification for glenoid fractures according to Ideberg et al 18 and Goss 15 does not consider the rest of the scapula; simple glenoid fracture lines between anterior and posterior rim fractures (types Ia and Ib) and transverse fractures (types II-V) are distinguished, and type VI fractures represent multifragmentary fractures. The classification of scapular fractures by Ada and Miller 1 distinguishes among 4 types of fractures including type III glenoid fractures; however, further subclassifications of glenoid fractures do not exist. This evaluation is limited by its sample size, although it is one of the largest ever used in such a project. There is often a tradeoff between increasing the case collection and making the evaluation feasible when busy clinicians are involved. Results should be considered with caution when the number of cases in any category is low, such as in the more detailed a, b, and c category system. In addition, nothing can be said about the reliability of coding multifragmentary glenoid fossa fractures with central fracture-dislocation. Although classification of F1 simple fossa fractures according to anterior rim, posterior rim, or transverse patterns appears reasonably reliable and accurate, location of these fractures with regard to the 4 quadrants remains open for further clarification and evaluation. The wide range of surgeons’ pair-wise k coefficients shows that different applications of the definitions occurred among surgeons; thus, further clarification and specification of the system are required. Transverse or short oblique fractures typically separate a process (ie, coracoid 3c) or involve the body (3a and 3b). The 3a and 3b fractures are typically located near the equator. In contrast, 1c and 2c rim fractures are much smaller because they are located near the glenoid edge. The classification process and evaluation sessions were performed by experienced surgeons only, which may not reflect the validity of the system in general practice. As advocated by Audige et al, 4 a further study is required to assess the reliability and accuracy of this classification system when used by surgeons of varying education and experience. Such evaluation would also consider the final change made to the rim fracture categories. This study could also be influenced by the preparation of the 3D volume rendering datasets by only the main author. Furthermore, this report is not intended to make recommendations regarding any treatment modalities based on this classification system at this early stage; rather, our intent is to provide
520 M. Jaeger et al. a comprehensive, reliable, and accurate classification system as a base for further clinical examinations. Conclusion In summary, it was possible to create a comprehensive scapula classification system focusing also on fractures of the articular segment. This classification system is believed to be clinically relevant and appears reasonably reliable and accurate with respect to glenoid fractures at both the basic and more detailed levels. Further validation of the most detailed system in a larger case sample with surgeons of different training backgrounds should be considered. Acknowledgments The authors thank the following persons for their participation and support in the development of the basic scapula classification system: Edward Harvey (Montreal General Hospital, Montreal, Quebec, Canada), Dolfi Herscovici (Florida Orthopaedic Institute, Temple Terrace, FL, USA), and Julie Agel and Sean Nork (Harborview Medical Center, Seattle, WA, USA). The authors also thank M. Wilhelmi, PhD (AO Clinical Investigation and Documentation), for the preparation and copy editing of this manuscript. Disclaimer The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. The surgeons who participated in the successive faceto-face meetings were supported with regard to their travel expenses and received a small per-diem payment. Support for this study was provided by the AO Foundation. Supplementary data Supplementary data related to this article can be found online at http://dx.doi.org/10.1016/j.jse.2012.08.003. References 1. Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop Relat Res 1991:174-80. 2. Anavian J, Conflitti JM, Khanna G, Guthrie ST, Cole PA. A reliable radiographic measurement technique for extra-articular scapular fractures. Clin Orthop Relat Res 2011;469:3371-8. http://dx.doi.org/ 10.1007/s11999-011-1820-3 3. Armitage BM, Wijdicks CA, Tarkin IS, Schroder LK, Marek DJ, Zlowodzki M, et al. Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg Am 2009; 91:2222-8. http://dx.doi.org/10.2106/JBJS.H.00881 4. Audige L, Bhandari M, Hanson B, Kellam J. A concept for the validation of fracture classifications. J Orthop Trauma 2005;19:404-9. http://dx.doi.org/10.1097/01.bot.0000155310.04886.37 5. Audige L, Bhandari M, Kellam J. How reliable are reliability studies of fracture classifications? A systematic review of their methodologies. Acta Orthop Scand 2004;75:184-94. http://dx.doi.org/10.1080/ 00016470412331294445 6. Audige L, Hunter J, Weinberg A, Magidson J, Slongo T. Development and evaluation process of a paediatric long-bone fracture classification proposal. Eur J Trauma 2004;30:248-54. http://dx.doi.org/10.1007/ s00068-004-1428-3 7. Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR Jr. Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. J Bone Joint Surg Am 2009;91:2492-510. 8. Bartonicek J, Tucek M, Fric V. Radiographic evaluation of scapula fractures [in Czech]. Rozhl Chir 2009;88:84-8. 9. Burstein AH. Fracture classification systems: do they work and are they useful? J Bone Joint Surg Am 1993;75:1743-4. 10. Euler E, Habermeyer P, Kohler W, Schweiberer L. Scapula fracturesdclassification and differential therapy [in German]. Orthopade 1992;21:158-62. 11. Garbuz DS, Masri BA, Esdaile J, Duncan CP. Classification systems in orthopaedics. J Am Acad Orthop Surg 2002;10:290-7. 12. Gauger EM, Cole PA. Surgical technique: a minimally invasive approach to scapula neck and body fractures. Clin Orthop Relat Res 2011;469:3390-9. http://dx.doi.org/10.1007/s11999-011-1970-3 13. Goss TP. Frequency of scapular fractures. In: Rockwood CA, Matsen FA, Wirth MA, Lippitt SB, editors. Fractures of the scapula. 3rd ed. Philadelphia: Saunders; 2004. p. 413-54. 14. Goss TP. Scapular fractures and dislocations: diagnosis and treatment. J Am Acad Orthop Surg 1995;3:22-33. 15. Goss TP. Fractures of the glenoid cavity. J Bone Joint Surg Am 1992; 74:299-305. 16. Hardegger FH, Simpson LA, Weber BG. The operative treatment of scapular fractures. J Bone Joint Surg Br 1984;66:725-31. 17. Harvey E, Audige L, Herscovici D, Agel J, Madsen JE, Babst R, et al. Development and validation of the new international classification for scapula fractures. J Orthop Trauma 2012;26:364-9. http://dx.doi.org/ 10.1097/BOT.0b013e3182382625 18. Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand 1995; 66:395-7. 19. Martin JS, Marsh JL. Current classification of fractures. Rationale and utility. Radiol Clin North Am 1997;35:491-506. 20. Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation. Clin Orthop Relat Res 1998:122-30. 21. Tadros AM, Lunsjo K, Czechowski J, Corr P, Abu-Zidan FM. Usefulness of different imaging modalities in the assessment of scapular fractures caused by blunt trauma. Acta Radiol 2007;48:71-5. http://dx.doi.org/10.1080/02841850601026435 22. Uebersax JS, Grove WM. Latent class analysis of diagnostic agreement. Stat Med 1990;9:559-72. 23. Vermunt J, Magidson J. Latent class cluster analysis. In: Hagenaars JA, McCutcheon AL, editors. Applied latent class analysis. Cambridge: Cambridge University Press; 2002. p. 89-106. 24. Zlowodzki M, Bhandari M, Zelle BA, Kregor PJ, Cole PA. Treatment of scapula fractures: systematic review of 520 fractures in 22 case series. J Orthop Trauma 2006;20:230-3. http://dx.doi.org/10.1097/ 00005131-200603000-00013
Page 1 and 2: J Shoulder Elbow Surg (2013) 22, 51
Page 3 and 4: 514 M. Jaeger et al. Figure 1 Fract
Page 5 and 6: 516 M. Jaeger et al. Figure 5 Focus
Page 7: 518 M. Jaeger et al. Figure 7 Fract

scapula fracture classification system - Kreiskrankenhaus Mechernich

Create successful ePaper yourself

Delete template?

Save as template?