Diagnosing displaced four-part fractures of the proximal humerus: a review of observer studies.
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 Published and unpublished data from five observer studies were reviewed.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.
Department of Orthopaedic Surgery, Herlev University Hospital, Herlev, Denmark. sbrorson@hotmail.com
Stig
S
Brorson
Jens
J
Bagger
Annette
A
Sylvest
Asbjørn
A
Hrobjartsson
D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D015588:Observer Variation; D011183:Postoperative Complications / Q000503:physiopathology; D011379:Prognosis; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D018570:Risk Assessment; D012784:Shoulder Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed