Abstract
Objective To analyze the reproducibility, reliability, and demographics of a simplified anatomical
scaphoid fracture classification based on posteroanterior radiographs using a large
database of scaphoid fractures.
Methods The study consisted of a retrospective review of electronic medical records of 871
consecutive patients. All patients presented between 2003 and 2014 at two centers.
Patient- and surgeon-related factors were analyzed. Additionally, interobserver reliability
of the Herbert and simplified scaphoid fracture classifications were tested.
Results Proximal pole fractures were defined as fractures in which the center of the fracture
line was proximal to the distal scapholunate interval (n = 30), waist fractures (n = 802)
were defined as fractures involving the scaphocapitate interval, and distal tubercle
fractures (n = 39) were defined as fractures involving the scaphotrapeziotrapezoid
(STT) interval. The interobserver reliability of the simplified classification was
fair (κ = 0.37) as for the Herbert classification (κ = 0.31). The average doubt of
the answers of the observers was 2.1 on a scale from 0 to 10 for the simplified classification
and 3.6 for the Herbert classification (P < 0.05).
Conclusions All complete fractures across the entire scaphoid distal to the scapholunate articulation
and proximal to the STT joint can be classified as waist fractures; nonwaist scaphoid
fractures are uncommon (6%) and have somewhat different presentations compared to
waist fractures. Simplifying the fracture classification slightly improves interobserver
reliability, although remaining fair, and significantly reduces doubt.
Level of Evidence This is a Level III, prognostic study.
Keywords
scaphoid fracture - reproducibility - demographics - classification
