title: Treatment of proximal humerus fractures: comparison of shoulder and trauma surgeons.
abstract: Surgeons' disagreement about ideal treatment for proximal humerus fractures (PHFs) may reflect a difference in training. We conducted a study to compare treatment decision-making by experienced shoulder and trauma fellowship--trained surgeons. Two expert shoulder surgeons and 2 expert trauma surgeons reviewed 100 consecutive PHFs surgically treated at another institution. Using available imaging, the examiners assigned scores for agreement with treatment decisions and for ratings of reduction/arthroplasty placement, fixation method, and radiographic outcomes. The scores were evaluated for interobserver reliability using intraclass correlation coefficients. Overall, these experienced surgeons agreed poorly with treatment decisions and fixation methods but agreed moderately on acceptable reductions/arthroplasty placement and final radiographic outcomes. Agreement on the final radiographic outcomes was more uniform and acceptable for both shoulder and trauma surgeons. Trauma surgeons agreed more with each other about treatment decisions than shoulder surgeons agreed with each other. In this study, surgeon disagreement and an aging population highlight the need for better evidence regarding optimal treatment for PHFs in order to improve consensus.
authors: Andrew
authors: A
authors: Jawa
authors: University of California San Francisco, San Francisco, CA. paulyi88@gmail.com.
authors: Paul H
authors: PH
authors: Yi
authors: Robert E
authors: RE
authors: Boykin
authors: Michael J
authors: MJ
authors: Gardner
authors: Christian
authors: C
authors: Gerber
authors: Dean G
authors: DG
authors: Lorich
authors: Gilles
authors: G
authors: Walch
authors: Jon J P
authors: JJ
authors: Warner
mesh_terms: D002983:Clinical Competence; D003657:Decision Making; D006801:Humans; D015588:Observer Variation; D009985:Orthopedics / Q000193:education; D011859:Radiography; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D014194:Traumatology / Q000193:education