Goj. Sjoden et al., POOR REPRODUCIBILITY OF CLASSIFICATION OF PROXIMAL HUMERAL FRACTURES - ADDITIONAL CT OF MINOR VALUE, Acta orthopaedica Scandinavica, 68(3), 1997, pp. 239-242
Fractures of the proximal humerus can be described using the Neer and
AO fracture classifications. To assess the reproducibility and reliabi
lity of these classifications, we investigated 26 proximal humeral fra
ctures with both plain radiographs and CT. 5 specialists in orthopedic
surgery and 5 specialists in radiology independently classified all r
adiographs on 2 occasions. There was a moderate agreement between the
observers when using the Neer classification, but only a fair agreemen
t with the AO classification. The Neer system had a kappa value of 0.4
2 and the AO had a value of 0.31 in the first assessment. In the secon
d assessment the kappa Values were 0.45 and 0.30, respectively. Intrao
bserver reproducibility was slight to almost perfect agreement with Ne
er (kappa range 0.20-0.85) and slight to moderate agreement with AO (k
appa range 0.16-0.60). The observers most familiar with shoulder fract
ure radiographs and shoulder fracture treatment were more consistent i
n their classifications. We conclude that even with GT,the fracture cl
assifications of Neer and AO have a low consistency. Neither classific
ation system is reproducible enough to allow comparisons of different
studies.