Standard Unilateral Radiographs Insufficient to Determine Clavicle Fracture Shortening

Standard, plain unilateral radiographs of the clavicle were not sufficient for fellowship-trained orthopedic surgeons to reliably determine the degree of clavicle fracture shortening or the need for surgery, according to results from a recent cohort study.

Researchers selected 30 anteroposterior and 30-degree cephalad radiographs representing midshaft clavicle fractures treated both operatively and nonoperatively for evaluation and created clinical scenarios for each set of radiographs. Evaluators were asked to measure the degree of shortening in millimeters and to determine the percentage of displacement, whether the fracture was comminuted and state whether they would treat the fractures operatively or nonoperatively.

The researchers distributed the radiographs to 22 shoulder/sports medicine fellowship-trained orthopaedic surgeons. Approximately three months later, the radiographs were reordered and redistributed, with 16 surgeons completing one round of surveys and 13 surgeons completing both rounds.

The researchers found a moderate interrater agreement for displacement of 0 percent to 49 percent and greater than 100 percent, and minimal agreement for displacement of 50 percent to 100 percent. A moderate interrater agreement was seen for the presence/absence of comminution, a weak interrater agreement was seen for shortening of 0 mm to 5 mm, and minimal agreement was seen for shortening of 5.1 mm to 10 mm, according to the researchers.

Interrater analysis also showed weak agreement on recommendation of surgical treatment, but a strong agreement for comminution. Agreement was moderate for both displacement and operative treatment, and minimal for shortening.

Comminution and a displacement of greater than 100 percent predicted whether surgery was recommended, according to the researchers.