Imaging to improve agreement for proximal humeral fracture classification in adult patient: A systematic review of quantitative studies

Bougher, Hannah; Nagendiram, Archana; Banks, Jennifer; Hall, Leanne; Heal, Clare

doi:10.1016/j.jcot.2019.06.019

Cited by 7 publications

(14 citation statements)

References 37 publications

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“…A key factor contributing to limited agreement with the Neer system is a lack of clarity regarding the threshold for displacement. 3 , 4 , 34 Historically, this has varied leading to some uncertainty regarding its definition. 25 Displacement threshold of 1 cm likely appears more substantial if the humeral head diameter is 3.5 cm rather than 5 cm, which could contribute to disagreement.…”

Section: Discussionmentioning

confidence: 99%

“…Fractures with displacement closer to the 1-cm threshold are likely to be more contentious. 4 , 27 , 31 Muscles attached to fragments may cause displacement to change between different images. 26 , 31 Owing to the round structure, it is challenging to appreciate angulation or displacement of the humeral head.…”

Section: Discussionmentioning

confidence: 99%

“…26 , 31 Owing to the round structure, it is challenging to appreciate angulation or displacement of the humeral head. 27 There is likely more disagreement about complex fractures, 4 , 5 , 23 , 34 where it becomes increasingly difficult to assess displacement. 4 However, the amount of displacement helps determine management and is integral to PHF classification systems.…”

Section: Discussionmentioning

confidence: 99%

“… 27 There is likely more disagreement about complex fractures, 4 , 5 , 23 , 34 where it becomes increasingly difficult to assess displacement. 4 However, the amount of displacement helps determine management and is integral to PHF classification systems. 25 , 26 , 27 …”

Section: Discussionmentioning

confidence: 99%

“…The same study suggested CT may increase interobserver agreement to a greater extent for less experienced observers. 4 …”

mentioning

confidence: 99%

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Interobserver and intraobserver agreement of three-dimensionally printed models for the classification of proximal humeral fractures

Bougher¹,

Büttner²,

Smith³

et al. 2021

JSES International

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Hypothesis This study aimed to examine whether three-dimensionally printed models (3D models) could improve interobserver and intraobserver agreement when classifying proximal humeral fractures (PHFs) using the Neer system. We hypothesized that 3D models would improve interobserver and intraobserver agreement compared with x-ray, two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) and that agreement using 3D models would be higher for registrars than for consultants. Methods Thirty consecutive PHF images were selected from a state-wide database and classified by fourteen observers. Each imaging modality (x-ray, 2D CT, 3D CT, 3D models) was grouped and presented in a randomly allocated sequence on two separate occasions. Interobserver and intraobserver agreements were quantified with kappa values (κ), percentage agreement, and 95% confidence intervals (CIs). Results Seven orthopedic registrars and seven orthopedic consultants classified 30 fractures on one occasion (interobserver). Four registrars and three consultants additionally completed classification on a second occasion (intraobserver). Interobserver agreement was greater with 3D models than with x-ray (κ = 0.47, CI: 0.44-0.50, 66.5%, CI: 64.6-68.4% and κ = 0.29, CI: 0.26-0.31, 57.2%, CI: 55.1-59.3%, respectively), 2D CT (κ = 0.30, CI: 0.27-0.33, 57.8%, CI: 55.5-60.2%), and 3D CT (κ = 0.35, CI: 0.33-0.38, 58.8%, CI: 56.7-60.9%). Intraobserver agreement appeared higher for 3D models than for other modalities; however, results were not significant. There were no differences in interobserver or intraobserver agreement between registrars and consultants. Conclusion Three-dimensionally printed models improved interobserver agreement in the classification of PHFs using the Neer system. This has potential implications for using 3D models for surgical planning and teaching.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The same study suggested CT may increase interobserver agreement to a greater extent for less experienced observers. 4 …”

mentioning

confidence: 99%

See 3 more Smart Citations

Interobserver and intraobserver agreement of three-dimensionally printed models for the classification of proximal humeral fractures

Bougher¹,

Büttner²,

Smith³

et al. 2021

JSES International

Self Cite

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The effect of addition of 2DCT scans and 3DCT scans for the classification of tibial plateau fractures: a systematic review

Huitema,

van der Gaast,

Jaarsma

et al. 2023

Eur J Trauma Emerg Surg

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Purpose In this systematic review, we evaluate the effect of radiographs and 2D and 3D imaging techniques on the interobserver agreement of six commonly used classification systems for tibial plateau fractures. Methods In accordance with PRISMA guidelines, PubMed, Cochrane, Embase and Web of Science were searched for studies regarding the effect of 2D and 3D imaging techniques on the interobserver agreement of tibial plateau classification systems. Studies validating new classification systems, not providing own data or only providing information on the interobserver agreement for radiographs were excluded. Studies were scored based on the ROBINS-I risk of bias tool. Results Our review analysed 14 studies on different classification systems used for tibial plateau fractures in clinical practice, with the Schatzker classification being the most commonly used classification system. The results showed that the addition of 2D CT led to a significant improvement of interobserver agreement for one study. However, other included studies showed varying levels of interobserver agreement, ranging from fair to substantial according to the interpretation by Landis and Koch. The addition of 3D CT resulted in a significant deterioration in one study for the Schatzker classification. Similar to the addition of 2D CT, the interobserver agreement for the Schatzker classification with the addition of 3D CT were heterogeneous ranging from fair to almost perfect according to the interpretation by Landis and Koch. Conclusions The use of 2D CT can be recommended for classifying tibial plateau fractures with the Schatzker classification, AO/OTA classification and Hohl classification. The value of 3D CT on the interobserver agreement of commonly used classification systems remains uncertain and unproven. Therefore, we do not recommend the use of 3D CT for the classification of tibial plateau fractures. Overall, the advancement of imaging techniques is not in line with the advancement in interobserver agreement on fracture classification.

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Reliability of teleconsultation in the diagnosis and treatment of proximal humeral fractures

Pamuk¹

2022

Emerg Radiol

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Purpose Teleconsultation has become a routine part of clinical practice. The question arises as to whether this is reliable or not. Various studies have assessed the reliability in fractures at other locations in the extremities, but there is no study investigating teleconsultation reliability for proximal humeral fractures, proximal humerus fractures, which are fractures that may cause difficulties in making diagnosis and treatment decisions. Our aim was to evaluate whether proximal humerus fractures could be accurately assessed via teleconsultation. Methods Retrospectively, the radiological images of 83 patients were included in the study. Diagnosis and treatment classifications were made by 4 experienced orthopedic specialists. Interobserver and intraobserver analyses were performed on diagnostic and therapeutic decisions based on two forms of evaluation, direct analysis of images in the picture archiving and communication system (PACS) and the analysis of photographs taken from the PACS computer screen that were sent via WhatsApp. Results It was observed that there were excellent interobserver and intraobserver compatibility values for Neer and AO classifications and treatment decisions. No significant difference was observed in the evaluation of the images transferred via WhatsApp and the direct evaluation of PACS images. Conclusion The reliability of teleconsultation was found to be high in the radiological evaluation of proximal humerus fractures. It is clear that these consultations cannot replace the evaluation of the patient as a whole; however, we think that rapid consultation can enable faster patient management and more accurate diagnosis, especially when under time constraints.

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Imaging to improve agreement for proximal humeral fracture classification in adult patient: A systematic review of quantitative studies

Cited by 7 publications

References 37 publications

Interobserver and intraobserver agreement of three-dimensionally printed models for the classification of proximal humeral fractures

Interobserver and intraobserver agreement of three-dimensionally printed models for the classification of proximal humeral fractures

The effect of addition of 2DCT scans and 3DCT scans for the classification of tibial plateau fractures: a systematic review

Reliability of teleconsultation in the diagnosis and treatment of proximal humeral fractures

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