The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on body involvement.

Abstract

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. 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. 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. 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.