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

Journal of Orthopaedic Surgery and Research

Volumn 6, Issue 1, 2011, Pages

  Foroohar, Abtin ^a   Tosti, Rick ^a   Richmond, John M ^a   Gaughan, John P ^a   Ilyas, Asif M ^b  

^a TEMPLE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b THOMAS JEFFERSON UNIVERSITY HOSPITAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTHROPLASTY; ARTICLE; CLASSIFICATION; COMPARATIVE STUDY; COMPUTER ASSISTED TOMOGRAPHY; FRACTURE FIXATION; HUMAN; HUMERUS; INJURY SCALE; METHODOLOGY; OBSERVER VARIATION; PROFESSIONAL COMPETENCE; RADIOGRAPHY; REPRODUCIBILITY; SHOULDER FRACTURE; THREE DIMENSIONAL IMAGING;

ARTHROPLASTY; FRACTURE FIXATION; HUMANS; HUMERUS; IMAGING, THREE-DIMENSIONAL; OBSERVER VARIATION; PROFESSIONAL COMPETENCE; RADIOGRAPHY; REPRODUCIBILITY OF RESULTS; SHOULDER FRACTURES; TOMOGRAPHY, X-RAY COMPUTED; TRAUMA SEVERITY INDICES;

EID: 79960875214     PISSN: None     EISSN: 1749799X     Source Type: Journal    
DOI: 10.1186/1749-799X-6-38     Document Type: Article

References (35)

1. Baron JA, Barrett JA, Karagas MR. The epidemiology of peripheral fractures. Bone 1996, 18(3 suppl):209-13S.
2. Neer CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 1970, 52:1077-89.
3. Neer CS. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 1970, 52:1090-103.
4. Bernstein J, Adler LM, Blank JE, Dalsey RM, Williams GR, Iannotti JP. Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone Joint Surg Am 1996, 78:1371-5.
5. Brien H, Noftall F, MacMaster S, Cummings T, Landells C, Rockwood P. Neer's classification system: a critical appraisal. J Trauma 1995, 38:257-60. 10.1097/00005373-199502000-00022, 7869449.
6. Brorson S, Bagger J, Sylvest A, Hrobjartsson A. Improved interobserver variation after training of doctors in the Neer system. A randomised trial J Bone Joint Surg Br 2002, 84:950-4.
7. Brorson S, Bagger J, Sylvest A, Hrobjartsson A. Low agreement among 24 doctors using the Neer-classification; only moderate agreement on displacement, even between specialists. Int Orthop 2002, 26:271-3. 10.1007/s00264-002-0369-x, 12378351.
8. Brorson S, Hróbjartsson A. Training improves agreement among doctors using the Neer system for proximal humeral fractures in a systematic review. J Clin Epidemiol 2008, 61(1):7-16. 10.1016/j.jclinepi.2007.04.014, 18083458.
9. Brorson S, Bagger J, Sylvest A, Hrobjartsson A. Diagnosing displaced four-part fractures of the proximal humerus: a review of observer studies. Int Orthop 2009, 33(2):323-7. 10.1007/s00264-008-0591-2, 2899076, 18536918.
10. Sallay PI, Pedowitz RA, Mallon WJ, Vandemark RM, Dalton JD, Speer KP. Reliability and reproducibility of radiographic interpretation of proximal humeral fracture pathoanatomy. J Shoulder Elbow Surg 1997, 6:60-9. 10.1016/S1058-2746(97)90072-0, 9071684.
11. Sidor ML, Zuckerman JD, Lyon T, Koval K, Cuomo F, Schoenberg N. The Neer classification system for proximal humeral fractures. An assessment of interobserver reliability and intraobserver reproducibility. J Bone Joint Surg Am 1993, 75:1745-50.
12. Sidor ML, Zuckerman JD, Lyon T, Koval K, Schoenberg N. Classification of proximal humerus fractures: the contribution of the scapular and axillary radiographs. J Shoulder Elbow Surg 1994, 3:24-7.
13. Siebenrock KA, Gerber C. The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg Am 1993, 75:1751-5.
14. Sjoden GOJ, Movin T, Guntner P, Aspelin P, Ahrengart L, Ersmark H, et al. Poor reproducibility of classification of proximal humeral fractures. Additional CT of minor value. Acta Orthop Scand 1997, 68:239-42. 10.3109/17453679708996692, 9246984.
15. Sjoden GOJ, Movin T, Aspelin P, Guntner P, Shalabi A. 3D-radiographic analysis does not improve the Neer and AO classifications of proximal humeral fractures. Acta Orthop Scand 1999, 70:325-8. 10.3109/17453679908997818, 10569259.
16. Shrader MW, Sanchez-Sotelo J, Sperling JW, Rowland CM, Cofield RH. Understanding proximal humerus fractures: image analysis, classification, and treatment. J Shoulder Elbow Surg 2005, 14:497-505. 10.1016/j.jse.2005.02.014, 16194741.
17. Kristansen B, Anderson UL, Olsen CA, et al. The Neer classification of fractures of the proximal humerus. An assessment of interobserver variation. Skeletal Radiol 1988, 17:420-2. 10.1007/BF00361661, 3238441.
18. Petit CJ, Millett PJ, Endres NK, Diller D, Harris MB, Warner JP. Management of proximal humeral fractures: Surgeons don't agree. J Shoulder Elbow Surg 2010, 19:446-451. 10.1016/j.jse.2009.06.012, 19800259.
19. Frandsen PA, Andersen E, Madsen F, Skjadt T. Garden's classification of femoral neck fractures. An assessment of interobserver variation. J Bone and Joint Surg 1988, 70-B(4):588-590.
20. Nielsen J0, Dons-Jensen H, Sorensen HT. Lauge-Hansen classification of malleolar fractures. An assessment of the reproducibility in 118 cases. Acta Orthop Scandinavica 1990, 61:385-387.
21. Thomsen NOB, Olsen LH, Nielsen ST. Kappa statistics in the assessment of observer variation: the significance of multiple observers classifying ankle fractures. J Orthop Sci 2002, 7:163-166. 10.1007/s007760200028, 11956974.
22. Neer CS. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg 2002, 11:389-400. 10.1067/mse.2002.124346, 12195260.
23. Mora-Guix JM, Gonzalez AS, Brugalla JV, Carril EC, Baños FG. Proposed protocol for reading images of humeral head fractures. Clin Orthop Relat Res 2006, 448. 225 33.
24. Castagno AA, Shuma WP, Kilcoyne RF, et al. Complex fractures of the proximal humerus: role of CT in treatment. Radiology 1987, 165:759-62.
25. Brunner A, Honigmann P, Treumann T, Babst R. The impact of stereo-visualisation of three-dimensional CT datasets on the inter- and intraobserver reliability of the AO/OTA and Neer classifications in the assessment of fractures of the proximal humerus. J Bone Joint Surg Br 2009, 91(6):766-71. 10.1302/0301-620X.91B6.22109, 19483230.
26. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas 1960, 20:37-46.
27. Fleiss J. Measuring nominal scale agreement among many raters. Pyschol Bull 1971, 76(5):378-382.
28. Landis JR, Koch GG. Measurement of observer agreement for categorical data. Biometrics 1977, 33:159-74. 10.2307/2529310, 843571.
29. Burstein AH. Fracture classification systems: do they work and are they useful?. J Bone Joint Surg Am 1993, 75:1743-1744.
30. Neer CS. Fracture classification systems. Do they work and are they useful? [correspondence]. J Bone Joint Surg Am 1994, 76:789.
31. Rockwood CA. Fracture classification systems. Do they work and are they useful? [correspondence]. J Bone Joint Surg Am 1994, 76:790.
32. Bigliani LU, Flatow EL, Pollock RG. Fracture classification systems. Do they work and are they useful? [correspondence]. J Bone Joint Surg Am 1994, 76:790-1.
33. Cuomo F. Fracture classifications systems. Do they work and are they useful? [correspondence]. J Bone Joint Surg Am 1994, 76:792.
34. Bernstein J. Fracture classification systems. Do they work and are they useful? [correspondence]. J Bone Joint Surg Am 1994, 76:792-3. 299-301.
35. Brennan R, Prediger D. Coefficient kappa: some uses, misuses, and alternatives. Educational and Psychological Measurement 1981, 41:687-699.