Do computed tomography and its 3D reconstruction increase the reproducibility of classifications of fractures of the proximal extremity of the humerus?

Matsushigue, Thaís; Franco, Valmir Pagliaro; Pierami, Rafael; Tamaoki, Marcel Jun Sugawara; Netto, Nicola Archetti; Matsumoto, Marcelo Hide

doi:10.1016/j.rboe.2014.03.016

Cited by 8 publications

(17 citation statements)

References 20 publications

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“…Tomographies showed higher agreement when classified according to AO and compared with radiographs, A1 0.535 kappa, C2 0.479, C3 0.311 with a 0.277 general mean, as shown in Tables 3 and 4. The values found were similar to the results of Matsushigue et al 9 , in which a 0.25 kappa value was obtained for radiographs and a 0.36 kappa for tomographies. The values were higher than in the analysis by Majed et al 10 , which showed weak inter-observer reliability, with a 0.11 kappa.…”

Section: Discussionsupporting

confidence: 91%

“…The AO is one of the most complete classification system, however, its intra-and inter-observer reproducibility has reduced. 1,9,11 In our study, we evaluated 54 patients with proximal humerus fracture, whose initial evaluation was performed by radiography and tomography with 3D reconstruction. In the evaluation of the inter-observer results regarding radiographs according to Neer classification, we observed that kappa agreement ranged between 0.083 (analysis with fractures classified into 3 parts), 0.204 (4 parts) and 0.275 (2 parts), with 0.178 general kappa, with p < 0.001.…”

Section: Discussionmentioning

confidence: 99%

“…A subdivision into 3 subgroups (1, 2 and 3) is added based on the degree of fragmentation and complexity of the fracture, obtaining 27 fractures with different patterns. 1,9 Conventional radiography has an important role in the initial evaluation. However, computed tomography and 3D reconstruction have stood out in observations of deviations, rotations and joint surface due to technology improvement.…”

Section: Introductionmentioning

confidence: 99%

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Inter/Intra-Observer Evaluation Between Radiographs and Tomographies for Proximal Humerus Fracture

et al. 2020

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Objective: The use of images in 3D reconstruction is an instrument that facilitates the interpretation of the fracture, observations of deviations, rotations and articular surface. Objective: To evaluate the inter-observer and intra-observer reliability of the Neer x AO proximal humerus fracture classification on radiographs versus computed tomography with three-dimensional reconstruction (3D). Methods: We evaluated the digital radiographs (anteroposterior and profile) and computerized tomography with 3D reconstruction of patients presenting with a proximal humerus fracture, surgically treated at an Orthopedics and Traumatology Service. All radiographs and computed tomography were classified (Neer and AO) by eight (8) orthopedic surgeons, specialists in the upper limb and sent, following the pre-established numeration by the author, in a spreadsheet to the author of the study. Results: The Neer and AO scores were more reproducible when determined by computed tomography with 3D reconstruction, mainly in fractures of greater complexity (Neer 4 parts and AO group C). However, in absolute values, inter and intra-observer reproducibility and concordance still remain low. Conclusion: Computed tomography with 3D reconstruction allows a better analysis of fractures of group C and Neer 4 parts. However, the inter and intra-observer agreement does not increase significantly in comparison to the radiographs. Level of evidence III, Study of non-consecutive patients, without gold standard, applied uniformly.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inter/Intra-Observer Evaluation Between Radiographs and Tomographies for Proximal Humerus Fracture

et al. 2020

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“…26 , 31 Owing to the round structure, it is challenging to appreciate angulation or displacement of the humeral head. 27 There is likely more disagreement about complex fractures, 4 , 5 , 23 , 34 where it becomes increasingly difficult to assess displacement. 4 However, the amount of displacement helps determine management and is integral to PHF classification systems.…”

Section: Discussionmentioning

confidence: 99%

“…26,31 Owing to the round structure, it is challenging to appreciate angulation or displacement of the humeral head. 27 There is likely more disagreement about complex fractures, 4,5,23,34 where it 2D, two-dimensional; 3D, three-dimensional; CI, confidence interval; CT, computed tomography. * Agreement has been defined using the Landis and Koch criteria (Table I).…”

Section: Discussionmentioning

confidence: 99%

Interobserver and intraobserver agreement of three-dimensionally printed models for the classification of proximal humeral fractures

Bougher¹,

Büttner²,

Smith³

et al. 2021

JSES International

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Hypothesis This study aimed to examine whether three-dimensionally printed models (3D models) could improve interobserver and intraobserver agreement when classifying proximal humeral fractures (PHFs) using the Neer system. We hypothesized that 3D models would improve interobserver and intraobserver agreement compared with x-ray, two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) and that agreement using 3D models would be higher for registrars than for consultants. Methods Thirty consecutive PHF images were selected from a state-wide database and classified by fourteen observers. Each imaging modality (x-ray, 2D CT, 3D CT, 3D models) was grouped and presented in a randomly allocated sequence on two separate occasions. Interobserver and intraobserver agreements were quantified with kappa values (κ), percentage agreement, and 95% confidence intervals (CIs). Results Seven orthopedic registrars and seven orthopedic consultants classified 30 fractures on one occasion (interobserver). Four registrars and three consultants additionally completed classification on a second occasion (intraobserver). Interobserver agreement was greater with 3D models than with x-ray (κ = 0.47, CI: 0.44-0.50, 66.5%, CI: 64.6-68.4% and κ = 0.29, CI: 0.26-0.31, 57.2%, CI: 55.1-59.3%, respectively), 2D CT (κ = 0.30, CI: 0.27-0.33, 57.8%, CI: 55.5-60.2%), and 3D CT (κ = 0.35, CI: 0.33-0.38, 58.8%, CI: 56.7-60.9%). Intraobserver agreement appeared higher for 3D models than for other modalities; however, results were not significant. There were no differences in interobserver or intraobserver agreement between registrars and consultants. Conclusion Three-dimensionally printed models improved interobserver agreement in the classification of PHFs using the Neer system. This has potential implications for using 3D models for surgical planning and teaching.

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Analysis of four-fragment fractures of the proximal humerus: the interest of 2D and 3D imagery and inter- and intra-observer reproducibility

Ohl

Mangin

Barbe

et al. 2017

Eur J Orthop Surg Traumatol

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The treatment of the four-part fractures of the proximal humerus remains a therapeutic challenge. The decision-making is based on preoperative criteria concerning the displacement of the fracture, the stability of the fracture and the risk of avascular necrosis of the humeral head. The aim of this study was to analyse the inter- and intra-observer reproducibility of those criteria previously described by Hertel. Three observers analysed three times 20 radiologic files comprising 2D X-rays, 2D CT scan and 3D reconstructions for the intra-observer study, and an expert committee was used to assess the inter-observer reproducibility. The Kappa coefficient was used to measure agreement. The Kappa coefficient founded poor to moderate agreement for the majority of the criteria after the 2D X-ray analysis. This coefficient was improved with the use of 2D CT scan and 3D reconstructions, in particular for the medial hinge assessment, the humeral head fracture and the metaphyseal extension. The reproducibility of the criteria described by Hertel on 2D X-rays is at least moderate. Reproducibility could be considerably improved by associating 2D scans and 3D reconstruction, in particular for the criteria related to prognosis for the vascularisation of the humeral head.

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Do computed tomography and its 3D reconstruction increase the reproducibility of classifications of fractures of the proximal extremity of the humerus?

Cited by 8 publications

References 20 publications

Inter/Intra-Observer Evaluation Between Radiographs and Tomographies for Proximal Humerus Fracture

Inter/Intra-Observer Evaluation Between Radiographs and Tomographies for Proximal Humerus Fracture

Interobserver and intraobserver agreement of three-dimensionally printed models for the classification of proximal humeral fractures

Analysis of four-fragment fractures of the proximal humerus: the interest of 2D and 3D imagery and inter- and intra-observer reproducibility

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