Inter-rater agreement on proximal humerus fracture treatment in Korea

Abstract

Proximal fracture, after distal radius fracture and proximal femur it affects a considerable number of adult and elderly patients due to trauma or falls [1]. The prevalence of proximal humerus fracture in hospital emergency care is substantial and corresponds to approximately 80% of humerus fractures and 5% of total fractures [2]. This prevalence continues to rise with extended life span and increased outdoor activity.A standardized classification system is needed for several purposes including communication between medical professionals, standardization of research, and, most importantly, for use in prognostication and to guide management and intervention. However, inter-rater agreement for classification and treatment selection of proximal humerus fractures is quite low, and decision making for the treatment of these fractures is challenging even for experienced surgeons [3,4]. To overcome these difficulties, several approaches, such as use of multiple Neer classifications, AO/OTA (Orthopaedic Trauma Association) [5], three-dimensional computed tomography (3D CT) [6], 3D handheld modeling [4,7], and artificial intelligence [8] have been reported. Thus, research on current approaches to treatment of proximal humerus fracture would be helpful to surgeons.A study by Kim et al. [9] in Clinics in Shoulder and Elbow investigated inter-rater and intra-rater agreement with respect to