The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on body involvement.
BACKGROUND
A comprehensive system has been developed by the AO Classification Advisory Group to allow in-depth classification of scapular fractures for clinical research and surgical decision making. This paper evaluates a detailed classification system of scapular body fractures to better address the need for clinical relevance.


METHODS
Seven experienced shoulder and orthopaedic trauma specialist surgeons participated in a follow-up series of agreement studies to specify and to evaluate the involvement of the body in scapula fractures. The last evaluation was conducted on a consecutive collection of 120 scapula fractures.


RESULTS
There was agreement in 82% of the 120 cases with an overall κ of 0.75 when the surgeons identified body (B) fractures. Surgeons were in full agreement about involvement of the lateral inferior, medial, and superior borders in 72%, 51%, and 69% of the 101 cases identified with body involvement, respectively. The proportion of correctly classified cases with lateral inferior, medial, and superior border involvements was 78% or greater.


CONCLUSIONS
Body involvement can be reliably identified by use of 3-dimensional computed tomography images. Surgeons could reliably and accurately identify superior, medial, and lateral border involvement, which is considered clinically relevant and likely sufficient for the treatment decision process and outcome prognosis. It should be applied by surgeons with a special interest in the shoulder in the framework of clinical routine as well as in research activities.
AO Clinical Investigation and Documentation, Dübendorf, Switzerland (now Upper Extremities, Schulthess Klinik, Zürich, Switzerland). Electronic address: laurent.audige@kws.ch.
Laurent
L
Audigé
Carolinas Medical Center, Department of Orthopaedic Surgery, Charlotte, NC, USA.
James F
JF
Kellam
The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
Simon
S
Lambert
Orthopaedic Department, Oslo University Hospital Ullevaal and Faculty of Medicine, University of Oslo, Oslo, Norway.
Jan Erik
JE
Madsen
Klinik für Unfallchirurgie, Luzerner Kantonsspital, Luzern, Switzerland.
Reto
R
Babst
Kreiskrankenhaus Mechernich GmbH, Abteilung Unfallchirurgie, Zentrum Orthopädie und Unfallchirurgie, Mechernich, Germany.
Jonas
J
Andermahr
Department of Orthopaedics & Traumatology, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Wilson
W
Li
Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität, Freiburg, Germany.
Martin
M
Jaeger
D050723:Fractures, Bone / Q000145:classification* / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D011379:Prognosis; D012540:Scapula / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed / Q000379:methods
Development of Diagnostic Test/Classification System; Level II; Scapula fracture; accuracy; diagnostic; fracture classification; reliability; scapula body