{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:49:07Z","timestamp":1747187347032,"version":"3.40.5"},"reference-count":20,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/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>Distal clavicle fracture classification directly affects the treatment decisions. It is unclear whether the classification systems implemented differ depending on surgeons' backgrounds. This study aimed to compare the interobserver agreement of four classification systems used for lateral clavicle fractures by shoulder specialists and general trauma surgeons.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Radiographs of 20 lateral clavicle fractures representing a full spectrum of adult fracture patterns were analyzed by eight experienced shoulder specialists and eight general trauma surgeons from 10 different hospitals. All cases were graded according to the Orthopedic Trauma Association (OTA), Neer, J\u00e4ger\/Breitner, and Gongji classification systems. To measure observer agreement, Fleiss' kappa coefficient (\u03ba) was applied and assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>When only X\u2010ray films were presented, both groups achieved fair agreement. However, when the 3D\u2010CT scan images were provided, improved interobserver agreement was found in the specialist group when the OTA, J\u00e4ger\/Breitner, and Gongji classification systems were used. In the generalist groups, improved agreement was found when using the Gongji classification system. In terms of interobserver reliability, the OTA, Neer, and J\u00e4ger\/Breitner classification systems showed better agreement among shoulder specialists, while a slightly lower level of agreement was found using the Gongji classification system. For the OTA classification system, interobserver agreement had a mean kappa value of 0.418, ranging from 0.446 (specialist group) to 0.402 (generalist group). For the Neer classification system, interobserver agreement had a mean kappa value of 0.368, ranging from 0.402 (specialist group) to 0.390 (generalist group). For the J\u00e4ger\/Breitner classification system, the inter\u2010observer agreement had a mean kappa value of 0.380, ranging from 0.413 (specialist group) to 0.404 (generalist group). For the Gongji classification system, interobserver agreement had a mean kappa value of 0.455, ranging from 0.480 (specialist group) to 0.485 (generalist group).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Generally speaking, 3D\u2010CT scans provide a richer experience that can lead to better results in most classification systems of lateral clavicle fractures, highlighting the value of digitization and specialization in diagnosis and treatment. Competitive interobserver agreement was exhibited in the generalist group using the Gongji classification system, suggesting that the Gongji classification is suitable for general trauma surgeons who are not highly experienced in the shoulder field.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13659","type":"journal-article","created":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T06:09:53Z","timestamp":1675145393000},"page":"2138-2143","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter Study"],"prefix":"10.1111","volume":"15","author":[{"given":"Jian","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Trauma Center Shanghai General Hospital affiliated to Shanghai Jiao Tong University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei\u2010Jin","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Trauma Center Shanghai General Hospital affiliated to Shanghai Jiao Tong University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian\u2010Hai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Trauma &amp; Orthopedics Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing\u2010Ming","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Upper Extremity Traumatology No.2 Tianjin Hospital  Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ding\u2010Su","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Center for Orthopedic Diseases Research Affiliated Traditional Chinese Medicine Hospital of South\u2010West Medical University  Lu Zhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The First People's Hospital of Zunyi City  Zunyi China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei\u2010Dong","family":"Ni","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The First Affiliated Hospital of Chongqing Medical University  Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Upper Limb Sichuan Province Orthpaedic Hospital  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Shanghai Jiao Tong University Affiliated Sixth People's Hospital  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Shanghai Tenth People's Hospital, Tongji University School of Medicine  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia\u2010Xiang","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Wuchuan Traditional Chinese Medicine Hospital  Zunyi China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming\u2010Gui","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Fenggang Traditional Chinese medicine hospital  Zunyi China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7280-6455","authenticated-orcid":false,"given":"Xiao\u2010Ming","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Trauma Center Shanghai General Hospital affiliated to Shanghai Jiao Tong University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,1,30]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2014.05.007"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-018-3075-x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/ortho.IJOrtho_485_18"},{"key":"e_1_2_7_5_1","first-page":"1","article-title":"Clavicle fractures in adults; current concepts","volume":"1","author":"Frima H","year":"2019","journal-title":"Eur J Trauma Emerg Surg"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001063"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00064-013-0280-1"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200207000-00007"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.44"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181ad5e92"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2021.10.018"},{"issue":"11","key":"e_1_2_7_12_1","first-page":"467","article-title":"Therapy related classification of lateral clavicular fracture","volume":"87","author":"J\u00e4ger M","year":"1984","journal-title":"Unfallheilkunde"},{"issue":"4","key":"e_1_2_7_13_1","first-page":"220","article-title":"Gongji classification and treatment strategies for lateral clavicle fractures","volume":"42","author":"Jianhong W","year":"2022","journal-title":"Chin J Orthop"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/0s.13633"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/001316446002000104"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/001316447303300309"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2016.11.007"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-019-02411-9"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13037-019-0228-y"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515593949"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.13659","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.13659","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.13659","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T21:25:18Z","timestamp":1692566718000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.13659"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,30]]},"references-count":20,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1111\/os.13659"],"URL":"https:\/\/doi.org\/10.1111\/os.13659","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"type":"print","value":"1757-7853"},{"type":"electronic","value":"1757-7861"}],"subject":[],"published":{"date-parts":[[2023,1,30]]},"assertion":[{"value":"2022-09-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-30","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}