{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T14:24:20Z","timestamp":1770906260644,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T00:00:00Z","timestamp":1671062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Current X\u2010ray\u2010based classification methods cannot describe all distal clavicle fracture (DCF) patterns, especially the osteoligamentous injury pattern of DCFs. We aimed to develop a novel classification based on the osteoligamentous injury pattern of the DCFs and investigated its reliability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All DCFs from January 2017 to January 2022 were respectively screened and 45 cases (mean age 20\u201378; male 31, female 14) met the including criteria and were enrolled. Based on their Zanca view X\u2010ray radiograph and three\u2010dimensional CT construction images, we analyzed the osteoligamentous injury pattern of each case, particularly the acromioclavicular (AC) and coracoclavicular ligaments and their bone attachment. Then we developed a novel classification method, five types in total, sorting all DCFs according to their lesion manifestations of osteoligamentous complex. Also, we investigated the inter\u2010 and intra\u2010observer reliability using kappa value.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A novel classification method for DCF was developed, manifesting the avulsion or rupture of conoid and trapezoid ligaments, and involvement of AC joint. Forty\u2010five cases of DCFs were included in this study. Among them, 11 (24.4%) were Type 1 fracture, three (6.7%) cases were Type 2, six cases (13.3%) were Type 3, 21 (46.7%) were Type 4, four (8.9%) were Type 5. Kappa values for inter\u2010observer agreement were 0.57 after first evaluation and 0.61 after second evaluation. Intra\u2010observer agreement was 0.72 for experienced shoulder specialist and 0.63 for radiologist.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This new classification method is reliable to use, supplementary to current classification systems, and emphasizes on the osteoligamentous complex injury when opting for the treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13633","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T06:42:05Z","timestamp":1671172925000},"page":"2025-2032","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Novel and Open Classification Emphasizing on Osteoligamentous Complex for Distal Clavicle Fractures"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3128-3077","authenticated-orcid":false,"given":"Zhihua","family":"Han","sequence":"first","affiliation":[{"name":"Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General Hospital Shanghai Jiaotong University  Shanghai China"},{"name":"Sino\u2010Euro Orthopaedics Network  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingming","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Upper Extremity Tianjin Hospital  Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianhong","family":"Wu","sequence":"additional","affiliation":[{"name":"Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General Hospital Shanghai Jiaotong University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun","family":"Bi","sequence":"additional","affiliation":[{"name":"Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General Hospital Shanghai Jiaotong University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiugeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General Hospital Shanghai Jiaotong University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5414-7516","authenticated-orcid":false,"given":"Haodong","family":"Lin","sequence":"additional","affiliation":[{"name":"Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General Hospital Shanghai Jiaotong University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shanghai General Hospital Shanghai Jiaotong University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoming","family":"Wu","sequence":"additional","affiliation":[{"name":"Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General Hospital Shanghai Jiaotong University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,12,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002640050376"},{"key":"e_1_2_9_3_1","volume-title":"Shoulder and elbow injuries in athletes: prevention, treatment and return to sport E\u2010book","author":"Erik F","year":"2017"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12893"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13310"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12726"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-196303000-00001"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-196805000-00007"},{"key":"e_1_2_9_9_1","unstructured":"CraigEV.Fractures of the clavicle the shoulder1998;428\u201382."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2018.05.015"},{"issue":"4","key":"e_1_2_9_11_1","first-page":"245","article-title":"Fracture of the clavicle with avulsion of the coracoid plaque. Apropos of 2 cases","volume":"101","author":"Latarjet M","year":"1975","journal-title":"Chirurgie"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2012.11.001"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00113-015-0003-1"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-012-1512-9"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2020.10.006"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-019-1518-x"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.19.00590"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12565-013-0179-9"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.4055\/cios20010"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514563281"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.5397\/cise.2018.21.4.227"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-018-2187-x"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2017.10.012"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1569253"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2011.01.004"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1569252"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcl.2018.03.003"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060520927874"},{"key":"e_1_2_9_29_1","article-title":"Preliminary study on the value of dual\u2010source CT energy spectrum purification single energy technique in evaluating coracoclavicular ligament","volume":"10","author":"Mei B","year":"2022","journal-title":"Chin J Shoulder Elbow (Electr Ed)"},{"issue":"2","key":"e_1_2_9_30_1","first-page":"773","article-title":"Diagnosis of coracoclavicular ligament injury in acute acromioclavicular dislocations by energy spectrum CT","volume":"2","author":"Zhang Y","year":"2022","journal-title":"Chin J Bone Joint"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.13633","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.13633","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.13633","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T21:25:43Z","timestamp":1692566743000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.13633"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,15]]},"references-count":29,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1111\/os.13633"],"URL":"https:\/\/doi.org\/10.1111\/os.13633","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,15]]},"assertion":[{"value":"2022-09-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}