Improved interobserver variation after training of doctors in the Neer system

Brorson, Stig; Bagger, Jens Peder; Sylvest, A.; Høbjartsson, A.

doi:10.1302/0301-620x.84b7.0840950

Cited by 17 publications

(4 citation statements)

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“…Other authors 6,9,13,14 have shown that intraobserver reliability, levels of clinical expertise, the number of fracture categories, and pretraining of observers may also impact on the validity of a classification, but not to the extent of changing the overall superior results revealed by our kappa analysis. Clinical implications.…”

Section: Discussionmentioning

confidence: 74%

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A three-dimensional classification for fractures of the proximal humerus

Edelson

Kelly

Vigder

et al. 2004

The Journal of Bone and Joint Surgery. British volume

122

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Existing classifications of fractures of the head of the humerus are inadequate in terms of interobserver reliability and the predictability of the clinical outcome. From a combined study of 73 fracture specimens in museums and 84 CT-three-dimensional reconstructions in patients, we have devised a classification which appears to be more useful clinically. Common patterns of fracture and a plausible mechanism of injury were observed. In 3-D most proximal humeral fractures can be organised into five basic types. These correspond in some degree to the Codman/Neer classification, but differ significantly in regard to the more complex patterns of fracture. We observed a logical progression from simple to complex fractures. An interobserver reliability study was carried out which indicated the improved usefulness of this new 3-D concept in providing a common language among clinicians for classifying these injuries. When surgery is indicated, the 3-D concept is also invaluable in guiding the restitution of anatomy through either open or percutaneous means.

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Section: Discussionmentioning

confidence: 74%

“…[6][7][8][9][10][11][12][13][14] There are other classifications 8,[15][16][17] but they are cumbersome, inaccurate, and for the most part, do not contain any underlying concept of the mechanism of injury which may be helpful in understanding the disparate patterns of bony displacement which characterise this injury.…”

mentioning

confidence: 99%

A three-dimensional classification for fractures of the proximal humerus

Edelson

Kelly

Vigder

et al. 2004

The Journal of Bone and Joint Surgery. British volume

122

View full text Add to dashboard Cite

show abstract

“…The literature regarding inter-observer agreement of fracture classifications appears to converge on the following paradigm: low inter-observer agreement is largely caused by compromised interpretation of the imaging, which is caused by imprecise measurements of the pathoanatomy. Moreover, Neer described patient, procedural, and clinical variability as causes of these imprecise measurements [ 22 ], and a few studies have improved precision through education [ 6 , 8 , 16 ]. Important to remember is that "the 4-segment classification is not a radiographic system but is a pathoanatomic classification of fracture displacement [ 22 ]."…”

Section: Discussionmentioning

confidence: 99%

Classification and treatment of proximal humerus fractures: inter-observer reliability and agreement across imaging modalities and experience

et al. 2011

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SummaryProximal humerus fractures (PHF) are common injuries, but previous studies have documented poor inter-observer reliability in fracture classification. This disparity has been attributed to multiple variables including poor imaging studies and inadequate surgeon experience. The purpose of this study is to evaluate whether inter-observer agreement can be improved with the application of multiple imaging modalities including X-ray, CT, and 3D CT reconstructions, stratified by physician experience, for both classification and treatment of PHFs.MethodsInter-observer agreement was measured for classification and treatment of PHFs. A total of sixteen fractures were imaged by plain X-ray (scapular AP and lateral), CT scan, and 3D CT reconstruction, yielding 48 randomized image sets. The observers consisted of 16 orthopaedic surgeons (4 upper extremity specialists, 4 general orthopedists, 4 senior residents, 4 junior residents), who were asked to classify each image set using the Neer system, and recommend treatment from four pre-selected choices. The results were evaluated by kappa reliability coefficients for inter-observer agreement between all imaging modalities and sub-divided by: fracture type and observer experience.ResultsAll kappa values ranged from "slight" to "moderate" (k = .03 to .57) agreement. For overall classification and treatment, no advanced imaging modality had significantly higher scores than X-ray. However, when sub-divided by experience, 3D reconstruction and CT scan both had significantly higher agreement on classification than X-ray, among upper extremity specialists. Agreement on treatment among upper extremity specialists was best with CT scan. No other experience sub-division had significantly different kappa scores. When sub-divided by fracture type, CT scan and 3D reconstruction had higher scores than X-ray for classification only in 4-part fractures. Agreement on treatment of 4 part fractures was best with CT scan. No other fracture type sub-division had significantly different kappa scores.ConclusionsAlthough 3D reconstruction showed a slight improvement in the inter-observer agreement for fracture classification among specialized upper extremity surgeons compared to all imaging modalities, fracture types, and surgeon experience; overall all imaging modalities continue to yield low inter-observer agreement for both classification and treatment regardless of physician experience.

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“…Previous imaging studies in other areas found that training resulted in marked improvement in interobserver agreement (Bankier et al., 1999; Berg et al., 2002; Brorson et al., 2002; Lujan et al., 2008; Magnan and Maklebust, 2009; Patel et al., 2007).…”

Section: Introductionmentioning

confidence: 96%

Influence of training on dorsal tangential radiographic view to detect screw protrusion after anterior plating of the distal radius: a cadaveric study

Bergsma

Obdeijn

Janssen

et al. 2020

J Hand Surg Eur Vol

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In this cadaveric study of anterior plating of the distal radius, we aimed to determine the interobserver agreement and diagnostic performance for detecting dorsally protruding screws using the dorsal tangential radiographic view before and after specific training. Without prior instruction, 13 observers interpreted the dorsal tangential view of cadaveric specimens, in which anterior radial plates were placed. After seeing a training video on the dorsal tangential view, they repeated the task. Though we found that accuracy and interobserver agreement was lower than described in some other clinical series, training led to statistically significant improvements of (1) the interobserver agreement on the decision to exchange screws, (2) the self-confidence of the surgeon in obtaining adequate views, and (3) the number of fluoroscopic images required to obtain these views. After training, the number of protruding screws missed was reduced by 36%, but 7% of dorsally protruding screws was still missed.

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Improved interobserver variation after training of doctors in the Neer system

Cited by 17 publications

References 0 publications

A three-dimensional classification for fractures of the proximal humerus

A three-dimensional classification for fractures of the proximal humerus

Classification and treatment of proximal humerus fractures: inter-observer reliability and agreement across imaging modalities and experience

Influence of training on dorsal tangential radiographic view to detect screw protrusion after anterior plating of the distal radius: a cadaveric study

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