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Revising the modified Neer classification for distal clavicle fractures: Description and reliability

  • Author Footnotes
    ⁎ Yin Zhang and Pei Yu contribute equally to this research.
    Yin Zhang
    Footnotes
    ⁎ Yin Zhang and Pei Yu contribute equally to this research.
    Affiliations
    Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025
    Search for articles by this author
  • Author Footnotes
    ⁎ Yin Zhang and Pei Yu contribute equally to this research.
    Pei Yu
    Footnotes
    ⁎ Yin Zhang and Pei Yu contribute equally to this research.
    Affiliations
    Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025
    Search for articles by this author
  • Chengyu Zhuang
    Affiliations
    Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025
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  • Jingfeng Liu
    Affiliations
    Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025
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  • Gen Li
    Affiliations
    Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Tingjun Ye
    Affiliations
    Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025
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  • Lei Wang
    Correspondence
    Corresponding author at: Department of Orthopedics, Ruijin Hospital, 197 Ruijin 2nd Road, Shanghai, China 200025.
    Affiliations
    Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025
    Search for articles by this author
  • Author Footnotes
    ⁎ Yin Zhang and Pei Yu contribute equally to this research.
Published:November 12, 2021DOI:https://doi.org/10.1016/j.injury.2021.11.018

      Highlights

      • We proposed a new classification method for distal clavicle fracture instead of the modified Neer classification which might be a slightly outdated.
      • We added anterior-posterior stability and coracoclavicular complex intergrity into our revised classification for distal clavicle fractures which was more accurate and suitable for classification and guiding treatment.
      • Notably, distal clavicle fractures might accompany with acromioclavicular ligament rupture. When we use pre-contoured plate alone, we should check the acromioclavicularv joint stability.

      Abstract

      Background

      The modified Neer classification is the most widely used classification system for distal clavicle fractures. However, it provides limited information for treatment decisions. The objective of this study was to revise the modified Neer classification to make it more suitable for treatment decision-making.

      Hypothesis

      The revised version of the modified Neer classification has good intra- and interobserver agreements and provides an instructive treating algorithm.

      Study design

      Cohort study

      Methods

      Six observers, including three experienced shoulder specialists and three junior orthopaedic residents, independently reviewed plain radiographs of 52 patients with distal clavicle fractures. They were asked to classify the fracture types according to the modified Neer classification and our revised new classification separately to determine treatment approaches for each patient. Images were mirrored and randomized to verify the intraobserver agreement. Reliabilities were measured using the Fleiss kappa values.

      Results

      Both the modified Neer classification and our revised version had near perfect intraobserver agreement (κ values: 0.87–1.00), whereas our revised Neer classification had a better interobserver agreement (κ values: 0.78 vs. 0.70, z = 4.70, p < 0.01) and stronger relevance to treatment decisions (coefficient of contingency: 0.70 vs. 0.44).

      Conclusion

      Our study demonstrated a near-perfect intraobserver and substantial interobserver agreement of the revised new classification, indicating that our revised new classification was better than the modified Neer classification. Meanwhile, our revised classification brought few disputes in treatment selection.

      Clinical relevance

      The modified Neer classification was revised to make it more accurate and suitable for guiding treatment.

      Type of study

      Study of diagnostic test

      Level of study

      Level II

      Keywords

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