Proximal humeral fracture classification systems revisited
Proximal humeral fracture classification systems revisited
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DOI：
10.1016/j.jse.2011.01.020
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发表时间：
2011-10-01
影响因子：
3
通讯作者：
Emery, Roger J. H.
中科院分区：
文献类型：
--
作者：
Majed, Addie;Macleod, Iain;Emery, Roger J. H.
假设：本研究评估了几种分类系统和专家外科医生对这些复杂损伤的解剖学理解，基于一系列连续的患者。我们假设，目前的肱骨近端骨折分类系统，无论成像方法，是不够可靠的，以帮助临床管理这些injuries.Materials和方法：复杂的骨折在96例连续进行了研究，由计算机断层扫描数字成像和通信医学（DICOM）成像数据生成的快速序列原型模型。要求四名独立的高级观察员使用4个分类系统对每个模型进行分类：Neer，AO，Codman-Hertel和Resch的原型分类系统。观察者间和观察者内的Kappa系数值进行计算的整体分类系统和选定的classificationites.Results：观察者间的信度的Kappa系数值为0.33 Neer，0.11 AO，0.44 Codman-Hertel，和0.15 Resch。使用Neer系统时，观察者间可靠性kappa系数值对于碎片数量为0.32，对于涉及的解剖节段为0.30，对于AO类型（A、B、C）为0.30，对于Resch撞击/牵引、内翻/外翻和屈曲/伸展亚组分别为0.53、0.48和0.08。三部分骨折表现出较低的可靠性Neer和AO system.Discussion：目前可用的证据表明，骨折分类在使用中有差的内部和观察者之间的可靠性，尽管使用的成像方式，从而使治疗这些损伤的困难，以及影响科学研究的薄弱。本研究进行了几个系统使用快速序列原型models.Conclusion的可靠性评估：整体interobserver kappa值代表轻微至中度协议。最可靠的观察者间评分是Codman-Hertel分类，其次是Resch试验系统的要素。AO系统的数值最低。odman-Hertel系统的观察者间可靠性较高，表明这是研究的唯一综合性骨折描述，而Resch的新分类显示了内翻/外翻和撞击/牵引成角的明确定义。证据等级：III级，诊断研究。(C)2011年《肩肘外科杂志》董事会。
Hypothesis: This study evaluated several classification systems and expert surgeons' anatomic understanding of these complex injuries based on a consecutive series of patients. We hypothesized that current proximal humeral fracture classification systems, regardless of imaging methods, are not sufficiently reliable to aid clinical management of these injuries.Materials and methods: Complex fractures in 96 consecutive patients were investigated by generation of rapid sequence prototyping models from computed tomography Digital Imaging and Communications in Medicine (DICOM) imaging data. Four independent senior observers were asked to classify each model using 4 classification systems: Neer, AO, Codman-Hertel, and a prototype classification system by Resch. Interobserver and intraobserver kappa coefficient values were calculated for the overall classification system and for selected classification items.Results: The kappa coefficient values for the interobserver reliability were 0.33 for Neer, 0.11 for AO, 0.44 for Codman-Hertel, and 0.15 for Resch. Interobserver reliability kappa coefficient values were 0.32 for the number of fragments and 0.30 for the anatomic segment involved using the Neer system, 0.30 for the AO type (A, B, C), and 0.53, 0.48, and 0.08 for the Resch impaction/distraction, varus/valgus and flexion/extension subgroups, respectively. Three-part fractures showed low reliability for the Neer and AO systems.Discussion: Currently available evidence suggests facture classifications in use have poor intra-and interobserver reliability despite the modality of imaging used thus making treating these injuries difficult as weak as affecting scientific research as well. This study was undertaken to evaluate the reliability of several systems using rapid sequence prototype models.Conclusion: Overall interobserver kappa values represented slight to moderate agreement. The most reliable interobserver scores were found with the Codman-Hertel classification, followed by elements of Resch's trial system. The AO system had the lowest values. The higher interobserver reliability values for the odman-Hertel system showed that is the only comprehensive fracture description studied, whereas the novel classification by Resch showed clear definition in respect to varus/valgus and impaction/distraction angulation.Level of evidence: Level III, Diagnostic Study. (C) 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.