3D reconstruction does not improve agreement and results in an increase in surgical indications in proximal humeral fractures.

The objective of this study is to analyze the effect of different imaging modalities in treatment decision making in proximal humeral fractures. After evaluation of 116 consecutive proximal humeral fractures, observers were asked to give treatment recommendation (conservative vs. surgery). If surgery was proposed, they were told to select surgery of choice. When 3D imaging was added, complexity of fractures significantly increased (p < 0.001), number of surgeries significantly increased (p < 0.000) and number of ORIF treatments significantly increased (p < 0.0004). Addition of 3D imaging of proximal humeral fractures significantly increases number of surgical decisions when compared to radiographs alone or together with CT.