Distal clavicle fractures: A new classification system

Inter- and intraobserver agreement of three classification systems for lateral clavicle fractures – reliability comparison between two specialist groups

“…Only a few of the classification systems for lateral clavicle fractures, e.g. Neer, modified Neer classification system, and the new classification system for lateral clavicle fractures by Cho et al have been evaluated for their reliability [13–15].…”

“…Furthermore, it underscores the need for both a meticulous clinical examination as well as imaging in determining individualized treatment options. As Bishop et al [14] rated the fracture stability and size of the distal fragment as important factors in making the decision to operate and which implant to use, Cho et al [15] devised a new classification system for lateral clavicle fractures by taking into account fracture displacement and stability as well as fracture location. This new classification system, which is not a widespread concept in practice and therefore not tested in this study, demonstrated moderate interobserver (κ = 0.434) and substantial intraobserver (κ = 0.644) reliability [15].…”

“…As Bishop et al [14] rated the fracture stability and size of the distal fragment as important factors in making the decision to operate and which implant to use, Cho et al [15] devised a new classification system for lateral clavicle fractures by taking into account fracture displacement and stability as well as fracture location. This new classification system, which is not a widespread concept in practice and therefore not tested in this study, demonstrated moderate interobserver (κ = 0.434) and substantial intraobserver (κ = 0.644) reliability [15]. In their study, Cho et al included the evaluation of a total of eight investigators, four shoulder specialists and four orthopedic fellows at two different time points with only 4 weeks between the two evaluations.…”

“…Both operative and nonoperative management options have been advocated and remain without consensus opinion [1–8]. Various classification systems have been established for the description of clavicle fractures [9–12] and, yet, only the Neer, the modified Neer, and a new classification system described by Cho et al have had their reliability assessed [13–15]. In general, classification systems should accurately identify injury patterns to determine prognoses, to guide treatment decisions and have to be both reliable and valid [16].…”

Distal clavicle fractures with “superior intact cortical bone”: minimally invasive surgery

“…7 According to Cho et al, any pattern with a displacement  5 mm is considered unstable. 9 Several surgical techniques have been described for distal clavicle fracture treatment: coracoclavicular (CC) fixation (CC screws, subcoracoid suture loops, and cortical buttons) and fracture fixation devices (clavicular hook plate, clavicular locking plate, acromioclavicular screws, tension band, and transacromial fixation with K wires). 7,19,24,29 Despite multiple fixation techniques available, a relatively high rate of complication and reoperation have been described, therefore an ideal fixation method is yet to be determined.…”