POOR REPRODUCIBILITY OF CLASSIFICATION OF PROXIMAL HUMERAL FRACTURES - ADDITIONAL CT OF MINOR VALUE

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.