Poor reproducibility of classification of proximal humeral fractures: Additional CT of minor value

Sjödén, Göran O.; Movin, Tomas; Güntner, Peter; Aspelin, Peter; Ahrengart, Leif; Ersmark, Hans; Sperber, Anders

doi:10.3109/17453679708996692

Cited by 131 publications

(81 citation statements)

References 31 publications

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“…Five observer studies provided data allowing for calculation of interobserver agreement on displaced four-part fractures [20][21][22][23][24]. In three studies kappa values for interobserver agreement could be calculated from published data [20,23,24].…”

Section: Resultsmentioning

confidence: 99%

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Diagnosing displaced four-part fractures of the proximal humerus: a review of observer studies

Brorson

Bagger

Sylvest

et al. 2008

International Orthopaedics (SICOT)

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Displaced four-part fractures comprise 2-10 % of all proximal humeral fractures. The optimal treatment is unclear and randomised trials are needed. The conduct and interpretation of such trials is facilitated by a reproducible fracture classification. We aimed at quantifying observer agreement on the classification of displaced four-part fractures according to the Neer system. Published and unpublished data from five observer studies were reviewed. Observers agreed less on displaced four-part fractures than on the overall Neer classification. Mean kappa values for interobserver agreement ranged from 0.16 to 0.48. Specialists agreed slightly more than fellows and residents. Advanced imaging modalities (CT and 3D CT) seemed to contribute more to classification of displaced four-part patterns than in less complex fracture patterns. Low observer agreement may challenge the clinical approach to displaced four-part fractures and poses a problem for the interpretation and generalisation of results from future randomised trials.

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Section: Resultsmentioning

confidence: 99%

“…In three studies kappa values for interobserver agreement could be calculated from published data [20,23,24]. In two studies [21,22] the original data sheets were still available.…”

Section: Resultsmentioning

confidence: 99%

Diagnosing displaced four-part fractures of the proximal humerus: a review of observer studies

Brorson

Bagger

Sylvest

et al. 2008

International Orthopaedics (SICOT)

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“…Bernstein et al [2] reported a mean kappa value of 0.52. No significant improvement of mean kappa values has been demonstrated despite exclusive use of high-quality radiographs [2,13] or by adding CT scans and three-dimensional reconstructions [2,12,15,16].…”

Section: Discussionmentioning

confidence: 99%

“…1) of proximal humeral fractures is commonly used. Several previous studies have shown poor agreement between observers using the system [1,2,3,9,12,13,14,15,16]. Low agreement might explain conflicting study outcomes of the treatment of three-and four-part fractures [4].…”

Section: Introductionmentioning

confidence: 99%

Low agreement among 24 doctors using the Neer-classification; only moderate agreement on displacement, even between specialists

Brorson

Bagger

Sylvest

et al. 2002

International Orthopaedics

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Twenty-four orthopaedic surgeons classified 42 pairs of radiographs according to the Neer system for proximal humeral fractures. Mean kappa value for interobserver agreement was 0.27 (95% CI 0.26-0.28) with no clinically significant difference between orthopaedic residents (n=9), fellows (n=6) and specialists (n=9). Mean kappa for agreement of displacement versus nondisplacement was 0.41 (95% CI 0.39-0.43) overall, and 0.50 (95% CI 0.45-0.56) within the specialist group. The agreement found in our study is unsatisfactory from a clinical perspective.Résumé 24 chirurgiens orthopédistes ont classé 42 paires de radiographies selon la classification de Neer pour les fractures humérales proximales. La valeur moyenne du kappa pour l'accord inter-observateur était 0.27 (95% CI 0.26-0.28) sans différence significative entre résidents (n=9), chirurgiens juniors (n=6) et chirurgiens spécialistes (n=9). La valeur moyenne du kappa pour l'accord sur le critère déplacement ou non-déplacement était globalement 0.41 (95% CI 0.39-0.43), et, dans le groupe spécialiste 0.50 (95% CI 0.45-0.56). Dans une perspective clinique l'accord trouvé dans notre étude est peu satisfaisant.

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“…Such difference towards classifications' agreement could be due to multiple variables, for example, studies of low quality because of difficulties in placing patients with a fracture of proximal humerus, and also the surgeon's lack of experience to analyze these fractures (5)(6)(7)(8)(9)(10) . In spite of improvements demonstrated by some authors in the agreement of intra-and interobserver results using more complex tests like simple tomography and tridimensional (3D) reconstructions, these results are inconclusive when the relationship between classifications and suggestions of treatment is evaluated towards physician's experience (7)(8)(9) .…”

Section: Introductionmentioning

confidence: 99%

Reproducibility of three classifications of proximal humeral fractures

Carrerra

Wajnsztejn

Lenza

et al. 2012

Einstein (São Paulo)

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Objective: To propose a new system for classifying proximal humeral neck fractures, and to evaluate intra-and interobserver agreement using the Neer system that is the most commonly used in the area and the Arbeit Gemeinschaft für Osteosynthesefragen system created by an European group, and a new classification system proposed by the authors of this study. Methods: A total of 56 patients with proximal humeral fractures were selected, and submitted to digitized simple radiography in antero-posterior shoulder and scapular profile. Radiographs were analyzed by three observers at time one, and then three and six weeks later. The kappa coefficient modified by Fleiss was used for the analysis. Results: The mean intra-observer Kappa agreement index (k=0.687) of the new classification, was higher than both the Neer classification (k=0.362) and the Arbeit Gemeinschaft für Osteosynthesefragen (k=0.46). The mean interobserver Kappa agreement index (0.446) of the new classification, also had better results than both the Neer classification (k=0.063) and the Arbeit Gemeinschaft für Osteosynthesefragen (k=0.028). Conclusion: the new classification considering bone compression had higher results for intra-and interobserver compared to the Neer system, and the Arbeit Gemeinschaft für Osteosynthesefragen system. Keywords

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Poor reproducibility of classification of proximal humeral fractures: Additional CT of minor value

Cited by 131 publications

References 31 publications

Diagnosing displaced four-part fractures of the proximal humerus: a review of observer studies

Diagnosing displaced four-part fractures of the proximal humerus: a review of observer studies

Low agreement among 24 doctors using the Neer-classification; only moderate agreement on displacement, even between specialists

Reproducibility of three classifications of proximal humeral fractures

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