title: Neer's classification system: a critical appraisal.
abstract: The purpose of this study was to examine the interobserver agreement using Neer's classification system for fractures of the proximal humerus. A preliminary series of 28 fractures of the proximal humerus admitted to the hospital over a 5-year retrospective period was independently assessed by two radiologists and two orthopedic surgeons. The degree of agreement between paired observations was determined using a kappa statistic. The observations were assessed according to the number of fracture segments, as well as site of fracture segment. Most of the patients assessed were multisegment tuberosity fractures (n = 18). Results showed that the overall agreement between pairs of observers was 65% (average kappa = 0.45). It was also shown that, within the tuberosity group, the percentage agreement was 50%, with an average kappa = 0.35, indicating only fair interobserver agreement. Clinical implications of these findings are such that, as major surgical decisions are made dependent on Neer's classification, closer evaluation techniques--such as the computerized tomography scan and magnetic resonance imaging--should be used to classify the fracture segments accurately. This is particularly true with the fractured tuberosity subgroup.
authors.affiliation: Department of Surgery, Memorial University of Newfoundland, St. John's.
authors.forename: H
authors.initials: H
authors.lastname: Brien
authors.forename: F
authors.initials: F
authors.lastname: Noftall
authors.forename: S
authors.initials: S
authors.lastname: MacMaster
authors.forename: T
authors.initials: T
authors.lastname: Cummings
authors.forename: C
authors.initials: C
authors.lastname: Landells
authors.forename: P
authors.initials: P
authors.lastname: Rockwood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000145:classification* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed