Subscapular glenoid fracture is rare, accounting for only 0.11% of total body fractures and about 16.2% of scapular fractures. A comprehensive and reliable classification system for subscapular glenoid fractures is necessary. There are many classification systems to describe subscapular glenoid fractures, among which the most commonly used is the Ideberg classification based on X-ray films. However, there are still some shortcomings in fracture morphology, diagnostic accuracy, and completeness. In addition, OTA/AO classification and Bartoníclassification based on 3DCT have been proposed, which significantly improve the diagnostic accuracy and value for treatment decision-making. However, no studies have investigated the reliability of these three classifications in clinical practice. Objective The reliability of the new Bartoní classification in clinical practice was evaluated by comparison with Ideberg and OTA/AO classification.

Sixty-eight patients with scapular glenoid fractures diagnosed and treated in Beijing Chaoyang Hospital, Capital Medical University from January 2015 to January 2022 were enrolled with pre-treatment X-ray and 3DCT data. Four observers (2 orthopedic surgeons and 2 radiologists) classified the two images according to the classifications of Ideberg, OTA/AO, and Bartoní. After 4 weeks, all the original data were renumbered, and the fractures were again classified using the same method by 4 observers. Chron Kappa and intraclass correlation coefficient (ICC) were used to determine inter-observer and intra-observer consistencies for the three classifications.

Sixty-eight patients with a mean age of 41 (20 to 76) were enrolled in this study, including 52 males (76.5%). The mean inter-observer Kappa values of Bartoni, OTA/AO, and Ideberg classification based on 3DCT were 0.75±0.03, 0.70±0.03, and 0.57±0.03, respectively. The mean inter-observer Kappa values based on X-ray were 0.52±0.02, 0.46±0.02, 0.51±0.01, and the mean intra-observer ICC values based on 3DCT were 0.78±0.04, 0.72±0.02, 0.68±0.02, respectively. The mean intraobserver ICC values based on X-ray were 0.56±0.02, 0.51±0.02, and 0.55±0.02, respectively. The interobserver kappa values and intraobserver ICC values of Bartoni were significantly higher than those of OTA/AO and Ideberg (P < 0.05), whether based on radiographs or 3DCT.

Compared with OTA/AO classification and Ideberg classification, the Bartoní classification has more advantages in reliability.