Maritsa K Papakonstantinou1, Melissa J Hart2,3, Richard Farrugia4, Belinda J Gabbe5, Afshin Kamali Moaveni6, Dirk van Bavel1,7, Richard S Page8,9, Martin D Richardson7,10. 1. Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia. 2. Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), Melbourne, Victoria, Australia. 3. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 4. Department of Orthopaedics, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. 5. Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia. 6. Department of Orthopaedics, The Alfred Hospital, Melbourne, Victoria, Australia. 7. Department of Orthopaedics, The Epworth Hospital, Melbourne, Victoria, Australia. 8. Department of Orthopaedics, University Hospital, Geelong, Victoria, Australia. 9. School of Medicine, Deakin University, Geelong, Victoria, Australia. 10. Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: The classification of proximal humeral fractures remains challenging. The two main classification systems used, the Neer and the AO classification, have both been shown to have less than ideal interobserver agreement. Agreement in classification is required, however, to guide fracture management. METHOD: Data from the Victorian Orthopaedic Trauma Outcomes Registry were collected and the X-rays of 104 proximal humeral fractures were reviewed by three orthopaedic consultants. They classified the fractures according to the Neer and AO classifications, as well as their simplified versions. Interobserver agreement was then assessed using kappa statistics. RESULTS: Interobserver agreement was better overall in the Neer classification, which was moderate (kappa = 0.40-0.58), than the AO classification, which was fair to moderate (kappa = 0.31-0.54). When simplified, the Neer and AO classification interobserver agreement remained similar. CONCLUSION: The classification of proximal humeral fractures with both the Neer and the AO systems remains difficult with minimal improvements seen when reducing the number of categories in each classification system. From these results, the Neer classification system would appear slightly more useful in clinical practice to guide treatment.
BACKGROUND: The classification of proximal humeral fractures remains challenging. The two main classification systems used, the Neer and the AO classification, have both been shown to have less than ideal interobserver agreement. Agreement in classification is required, however, to guide fracture management. METHOD: Data from the Victorian Orthopaedic Trauma Outcomes Registry were collected and the X-rays of 104 proximal humeral fractures were reviewed by three orthopaedic consultants. They classified the fractures according to the Neer and AO classifications, as well as their simplified versions. Interobserver agreement was then assessed using kappa statistics. RESULTS: Interobserver agreement was better overall in the Neer classification, which was moderate (kappa = 0.40-0.58), than the AO classification, which was fair to moderate (kappa = 0.31-0.54). When simplified, the Neer and AO classification interobserver agreement remained similar. CONCLUSION: The classification of proximal humeral fractures with both the Neer and the AO systems remains difficult with minimal improvements seen when reducing the number of categories in each classification system. From these results, the Neer classification system would appear slightly more useful in clinical practice to guide treatment.
Authors: Simon Thelen; Jan P Grassmann; Madeleine Schneider; Carina Jaekel; Dana M Meier; Marcel Betsch; Mohssen Hakimi; Michael Wild Journal: GMS Interdiscip Plast Reconstr Surg DGPW Date: 2022-05-23
Authors: Guilherme Augusto Stirma; Armando Romani Secundino; Guilherme Ferreira Garcia Gonzalez; Wilson Carlos Sola; Geovanna Andrade Labres de Souza; Leonardo Dau Journal: Acta Ortop Bras Date: 2020 Jan-Feb Impact factor: 0.513