Epidemiology of Fracture of the Upper End of the Humerus

Horák, Jan; Nilsson, Bo

doi:10.1097/00003086-197510000-00032

Cited by 254 publications

(126 citation statements)

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“…However, comparisons of kappa values from different studies may be problematic, as kappa changes with the prevalence of the diagnosis [6]. In our sample we found a prevalence of displaced fractures of 79%, which is considerably higher than the prevalences reported by Neer [11] (20%), Horak and Nilsson [7] (39%), Kiaer et al [8] (57%) and Court-Brown et al [5] (51%). Our finding may be due to differences in classifying among our observers or due to an unrepresentative sample of radiographs.…”

Section: Discussioncontrasting

confidence: 61%

Low agreement among 24 doctors using the Neer-classification; only moderate agreement on displacement, even between specialists

Brorson

Bagger

Sylvest

et al. 2002

International Orthopaedics

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Twenty-four orthopaedic surgeons classified 42 pairs of radiographs according to the Neer system for proximal humeral fractures. Mean kappa value for interobserver agreement was 0.27 (95% CI 0.26-0.28) with no clinically significant difference between orthopaedic residents (n=9), fellows (n=6) and specialists (n=9). Mean kappa for agreement of displacement versus nondisplacement was 0.41 (95% CI 0.39-0.43) overall, and 0.50 (95% CI 0.45-0.56) within the specialist group. The agreement found in our study is unsatisfactory from a clinical perspective.Résumé 24 chirurgiens orthopédistes ont classé 42 paires de radiographies selon la classification de Neer pour les fractures humérales proximales. La valeur moyenne du kappa pour l'accord inter-observateur était 0.27 (95% CI 0.26-0.28) sans différence significative entre résidents (n=9), chirurgiens juniors (n=6) et chirurgiens spécialistes (n=9). La valeur moyenne du kappa pour l'accord sur le critère déplacement ou non-déplacement était globalement 0.41 (95% CI 0.39-0.43), et, dans le groupe spécialiste 0.50 (95% CI 0.45-0.56). Dans une perspective clinique l'accord trouvé dans notre étude est peu satisfaisant.

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Section: Discussioncontrasting

confidence: 61%

Low agreement among 24 doctors using the Neer-classification; only moderate agreement on displacement, even between specialists

Brorson

Bagger

Sylvest

et al. 2002

International Orthopaedics

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“…Neer´s (1970) classification of proximal humerus fractures based on the presence or absence of displacement of the 4 major fragments is shown in Figure 2. Proximal humeral fractures represent about 4% of all fractures seen in an average orthopedic clinic (Horak and Nilsson 1975). They commonly result from indirect injury such as a fall on the hand with the arm outstretched.…”

Section: Shouldermentioning

confidence: 99%

Multidetector computed tomography in acute joint fractures

Haapamäki

Kiuru²,

Mustonen³

et al. 2005

Acta Radiol

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Conventional radiography plays an essential diagnostic role in the primary evaluation of acute joint trauma. In complex fractures, however, computed tomography (CT) is an imaging modality often used second to radiography. As a result of technical breakthroughs in the field, multidetector CT (MDCT) allows faster imaging and better temporal, spatial, and contrast resolution compared with conventional single-slice spiral CT. MDCT with multiplanar reformation is helpful in disclosing fracture patterns, particularly in complex joint fractures, where they reveal occult fractures and show the exact number of fracture components and their degree of displacement.

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“…The rising number of humeral fractures undergoing operative treatment is related to a growing elderly population and an increase in the number of patients with osteoporosis [7,16,18]. Alternatively, these fractures can be treated by intramedullary nailing or with open reduction and internal fixation with plates and screws.…”

Section: Introductionmentioning

confidence: 99%

High Rates of Occult Infection after Shoulder Fracture Fixation: Considerations for Conversion Shoulder Arthroplasty

Sabihi

Guenther

Kamath

et al. 2015

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Existing hardware may contribute to increased risk of bacterial contamination and subsequent periprosthetic joint infection (PJI) in conversion shoulder arthroplasty performed for failed fracture fixation. Questions/Purposes: This study examined the incidence of positive pre-operative aspiration and inflammatory marker data, along with correlation of pre-operative positive aspiration or inflammatory markers and subsequent infection following conversion shoulder arthroplasty for failed open reduction and internal fixation (ORIF) and the need for reoperation at 4.6-year follow-up. Methods: Twenty-eight patients who underwent conversion to shoulder arthroplasty for any reason after fracture fixation were retrospectively reviewed in a single center. A pre-operative aspiration was done in 17 patients; all patients had intra-operative tissue sampling. All procedures were single-stage removal of hardware and performance of the arthroplasty. In cases of preoperative positive bacterial growth, a single-stage procedure was performed according to the septic ENDO-Klinik protocol. Results: In 4 of 17 pre-operative joint aspirations, bacterial growth was detected; one pre-operative negative aspiration demonstrated bacterial growth in intra-operative sampling. In three of them, the infection has been validated through intra-operatively results. Pre-operative aspiration showed a sensitivity of 75% and specificity of 92% (p<0.005) for infection. No post-operative PJIs were observed. Six revisions were performed, most commonly for aseptic loosening (two cases) and conversion of hemiarthroplasty to a reverse design (two cases). Conclusions: In conclusion, the risk of low-grade shoulder infection after fracture osteosynthesis may be higher than in hip and knee joints, based on limited study data. Adequate pre-operative testing is recommended to rule out occult shoulder infection in this setting.

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Epidemiology of Fracture of the Upper End of the Humerus

Cited by 254 publications

References 0 publications

Low agreement among 24 doctors using the Neer-classification; only moderate agreement on displacement, even between specialists

Low agreement among 24 doctors using the Neer-classification; only moderate agreement on displacement, even between specialists

Multidetector computed tomography in acute joint fractures

High Rates of Occult Infection after Shoulder Fracture Fixation: Considerations for Conversion Shoulder Arthroplasty

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