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J Wrist Surg 2019; 08(06): 446-451
DOI: 10.1055/s-0039-1692470
Special Review: Scaphoid Fracture Patterns
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Scaphoid Fracture Patterns—Part Two: Reproducibility and Demographics of a Simplified Scaphoid Fracture Classification

Tessa Drijkoningen
1   Hand and Arm Center, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Amin Mohamadi
1   Hand and Arm Center, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Wouter F. van Leeuwen
1   Hand and Arm Center, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Yonatan Schwarcz
2   Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
,
David Ring
3   Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, Texas
,
Geert A. Buijze
4   Hand and Upper Extremity Surgery Unit, Lapeyronie University Hospital, Montpellier, France
› Author Affiliations
Funding None.
Further Information

Publication History

31 July 2018

03 May 2019

Publication Date:
12 July 2019 (online)

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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

Ethical Committee

Partners Healthcare, Boston, United States.