title: 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.
abstract: We evaluated the impact of stereo-visualisation of three-dimensional volume-rendering CT datasets on the inter- and intraobserver reliability assessed by kappa values on the AO/OTA and Neer classifications in the assessment of proximal humeral fractures. Four independent observers classified 40 fractures according to the AO/OTA and Neer classifications using plain radiographs, two-dimensional CT scans and with stereo-visualised three-dimensional volume-rendering reconstructions. Both classification systems showed moderate interobserver reliability with plain radiographs and two-dimensional CT scans. Three-dimensional volume-rendered CT scans improved the interobserver reliability of both systems to good. Intraobserver reliability was moderate for both classifications when assessed by plain radiographs. Stereo visualisation of three-dimensional volume rendering improved intraobserver reliability to good for the AO/OTA method and to excellent for the Neer classification. These data support our opinion that stereo visualisation of three-dimensional volume-rendering datasets is of value when analysing and classifying complex fractures of the proximal humerus.
authors.affiliation: Department of Trauma Surgery, Cantonal Hospital, Lucerne, Switzerland. a-r.brunner@web.de
authors.forename: A
authors.initials: A
authors.lastname: Brunner
authors.forename: P
authors.initials: P
authors.lastname: Honigmann
authors.forename: T
authors.initials: T
authors.lastname: Treumann
authors.forename: R
authors.initials: R
authors.lastname: Babst
mesh_terms: D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000145:classification / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*