A new classification of impacted proximal humerus fractures based on the morpho-volumetric evaluation of humeral head bone loss with a 3D model

Russo, Roberto; Guastafierro, Antonio; Rotonda, Giuseppe Della; Viglione, Stefano; Ciccarelli, Michele; Mortellaro, Marco; Minopoli, Paolo; Fiorentino, Fabrizio; Pietroluongo, Livia Renata

doi:10.1016/j.jse.2020.02.022

Cited by 11 publications

(10 citation statements)

References 30 publications

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“…Recently, Raffaele Russo. et al [9], Fernando Carlos Mothes. et al [10] and You W. et al [11] used 3Dmodels to improve the surgical programming of proximal humerus fractures and reported good results.…”

Section: Introductionmentioning

confidence: 98%

Three-dimensional models increase the interobserver agreement for the treatment of proximal humerus fractures

et al. 2020

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Background: The agreement for the treatment of proximal humerus fractures is low. Interpretation of exams used for diagnosis can be directly associated with this limitation. This study proposes to compare the agreement between experts and residents in orthopedics for treatment indication of proximal humerus fractures, utilizing 3Dmodels, holography (augmented reality), x-rays, and tomography as diagnostic methods. Methods: Twenty orthopedists (ten experts in shoulder and elbow surgery and ten experts in traumatology) and thirty resident physicians in orthopedics evaluated nine fractures of the proximal humerus, randomly distributed as x-rays, tomography, 3D-models and holography, using the Neer and AO / OTA Classifications. After, we evaluated the interobserver agreement between treatment options (conservative, osteosynthesis and arthroplasty) and whether the experience of the evaluators interfered with the results. Results: The interobserver agreement analysis showed the following kappa-values: κ = 0.362 and κ = 0.306 for experts and residents (3D-models); κ = 0.240 and κ = 0.221 (X-ray); κ = 0.233 and κ = 0.123 (Tomography) and κ = 0.321 and κ = 0.160 (Holography), for experts and residents respectively. Moreover, residents and specialists were discordant in the treatment indication using Tomography as a diagnostic method (p = 0.003). The same was not seen for the other diagnostic methods (p > 0.05). Conclusions: Three-dimensional models showed, overall, the highest interobserver agreement (experts versus residents in orthopedics) for the choice of treatment of proximal humerus fractures compared to X-ray, Tomography, and Holography. Agreement in the choice of treatment among experts that used Tomography and Holography as diagnostic methods were two times higher compared to residents.

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Section: Introductionmentioning

confidence: 98%

Three-dimensional models increase the interobserver agreement for the treatment of proximal humerus fractures

et al. 2020

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“…Additionally, this study should be repeated in a prospective design with patient-reported outcomes and follow-up radiographs at fixed time points. An interobserver study should be carried out to assess the reliability of the Boileau classification to see if it can be incorporated as a subclassification of Neer's two-part fractures [14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Management of displaced humeral surgical neck fractures in daily clinical practice: hanging does not re-align the fracture

Spek

Hoogervorst

Elias

et al. 2022

Arch Orthop Trauma Surg

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Introduction It is unclear if the collar and cuff treatment improve alignment in displaced surgical neck fractures of the proximal humerus. Therefore, this study evaluated if the neckshaft angle and extent of displacement would improve between trauma and onset of radiographically visible callus in non-operatively treated surgical neck fractures (Boileau type A, B, C). Materials and Methods A consecutive series of patients (≥ 18 years old) were retrospectively evaluated from a level 1 trauma center in Australia (inclusion period: 2016–2020) and a level 2 trauma center in the Netherlands (inclusion period: 2004 to 2018). Patients were included if they sustained a Boileau-type fracture and underwent initial non-operative treatment. The first radiograph had to be obtained within 24 h after the initial injury and the follow-up radiograph(s) 1 week after trauma and before the start of radiographically visible callus. On each radiograph, the maximal medial gap (MMG), maximal lateral gap (MLG), and neck-shaft angle (NSA) were measured. Linear mixed modelling was performed to evaluate if these measurements would improve over time. Results Sixty-seven patients were included: 25 type A, 11 type B, and 31 type C fractures. The mean age (range) was 68 years (24–93), and the mean number (range) of follow-up radiographs per patient was 1 (1–4). Linear mixed modelling on both MMG and MLG revealed no improvement during follow-up among the three groups. Mean NSA of type A fractures improved significantly from 161° at trauma to 152° at last follow-up (p-value = 0.004). Conclusions Apart from humeral head angulation improvement in type A, there is no increase nor reduction in displacement among the three fracture patterns. Therefore, it is advised that surgical decision-making should be performed immediately after trauma. Level of clinical evidence Level IV, retrospective case series.

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“…Its prevalence in hospital emergency care is substantial and corresponds to approximately 45% of humerus fractures and 5% of total fractures [ 12 , 23 , 29 ]. However, understanding these fractures and the best way to treat them remains unsettled between doctors and researchers [ 8 , 9 , 11 , 22 , 24 , 25 ]..…”

Section: Introductionmentioning

confidence: 99%

“…Although PHF is relevant and is growing worldwide, controversies related to its diagnosis and treatment definitions are still frequent [ 8 , 9 , 11 , 17 , 22 , 25 ]. The classifications proposed by Charles Neer [ 22 ] and the AO/OTA group—Arbeit Gemeinschaft für Osteosynthesefragen [ 17 ] are widespread and used worldwide.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional printing models increase inter-rater agreement for classification and treatment of proximal humerus fractures

Cocco

Aihara

Lopes³

et al. 2022

Patient Saf Surg

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Background Proximal humerus fractures (PHF) are frequent, however, several studies show low inter-rater agreement in the diagnosis and treatment of these injuries. Differences are usually related to the experience of the evaluators and/or the diagnostic methods used. This study was designed to investigate the hypothesis that shoulder surgeons and diagnostic imaging specialists using 3D printing models and shoulder CT scans in assessing proximal humerus fractures. Methods We obtained 75 tomographic exams of PHF to print three-dimensional models. After, two shoulder surgeons and two specialists in musculoskeletal imaging diagnostics analyzed CT scans and 3D models according to the Neer and AO/OTA group classification and suggested a treatment recommendation for each fracture based on the two diagnostic methods. Results The classification agreement for PHF using 3D printing models among the 4 specialists was moderate (global k = 0.470 and 0.544, respectively for AO/OTA and Neer classification) and higher than the CT classification agreement (global k = 0.436 and 0.464, respectively for AO/OTA and Neer). The inter-rater agreement between the two shoulder surgeons were substantial. For the AO/OTA classification, the inter-rater agreement using 3D printing models was higher (k = 0.700) than observed for CT (k = 0.631). For Neer classification, inter-rater agreement with 3D models was similarly higher (k = 0.784) than CT images (k = 0.620). On the other hand, the inter-rater agreement between the two specialists in diagnostic imaging was moderate. In the AO/OTA classification, the agreement using CT was higher (k = 0.532) than using 3D printing models (k = 0.443), while for Neer classification, the agreement was similar for both 3D models (k = 0.478) and CT images (k = 0.421). Finally, the inter-rater agreement in the treatment of PHF by the 2 surgeons was higher for both classifications using 3D printing models (AO/OTA—k = 0.818 for 3D models and k = 0.537 for CT images). For Neer classification, we saw k = 0.727 for 3D printing models and k = 0.651 for CT images. Conclusion The insights from this diagnostic pilot study imply that for shoulder surgeons, 3D printing models improved the diagnostic agreement, especially the treatment indication for PHF compared to CT for both AO/OTA and Neer classifications On the other hand, for specialists in diagnostic imaging, the use of 3D printing models was similar to CT scans for diagnostic agreement using both classifications. Trial registration Brazil Platform under no. CAAE 12273519.7.0000.5505.

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A new classification of impacted proximal humerus fractures based on the morpho-volumetric evaluation of humeral head bone loss with a 3D model

Cited by 11 publications

References 30 publications

Three-dimensional models increase the interobserver agreement for the treatment of proximal humerus fractures

Three-dimensional models increase the interobserver agreement for the treatment of proximal humerus fractures

Management of displaced humeral surgical neck fractures in daily clinical practice: hanging does not re-align the fracture

Three-dimensional printing models increase inter-rater agreement for classification and treatment of proximal humerus fractures

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