Reliability of Current Classification Systems for Periprosthetic Fractures of the Humerus

Auran, Richard L; Tran, Tram L; Dehghan, Niloofar; McKee, Michael D.; Lederman, Evan

doi:10.1097/bot.0000000000002493

Cited by 2 publications

(7 citation statements)

References 24 publications

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“…Auran et al showed in their study applying the UCPF for PPSFx of the humerus substantial intra-rater reliability (κ: 0.51) and fair inter-rater reliability (κ: 0.29) [18]. In our study, we found higher, almost perfect intra-rater agreement (κ: 0.82) for grading PPSFx of the humerus and scapular.…”

Section: Discussionsupporting

confidence: 50%

“…Kuhn et al showed substantial intra-observer (κ: 0.703) and moderate inter-observer agreements (Fleiss' κ: 0.583) for the Wright & Cofield classification [17]. In 2022, Auran et al published an analysis of the intra-and interreliabilities of the Wright & Cofield classification, the UCPF and recommended treatment for seventy-six cases rated by three upper extremity-trained surgeons [18]. They determined a moderate intra-rater agreement (κ: 0.4.4) and a slight inter-rater agreement (κ: 0.04) for the Wright & Cofield classification [18].…”

Section: Discussionmentioning

confidence: 99%

“…The literature regarding intra-rater and inter-rater reliability for PPSFx shoulder classifications is still scarce. Previous studies evaluated the reliability of classification systems for humeral-sided PPSFx [17][18][19][20]. Kuhn et al and Auran demanded a more reliable and clinically relevant classification system [17,18].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies evaluated the reliability of classification systems for humeral-sided PPSFx [17][18][19][20]. Kuhn et al and Auran demanded a more reliable and clinically relevant classification system [17,18].…”

Section: Introductionmentioning

confidence: 99%

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Inter-Observer and Intra-Observer Reliability Assessment of the Established Classification Systems for Periprosthetic Shoulder Fractures

Wiethölter

Akgün

Plachel

et al. 2023

JCM

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This study evaluated the reliability and comprehensiveness of the Unified classification system (UCPF), Wright & Cofield, Worland and Kirchhoff classifications and related treatment recommendations for periprosthetic shoulder fractures (PPSFx). Two shoulder arthroplasty specialists (experts) and two orthopaedic residents (non-experts) assessed 20 humeral-sided and five scapula-sided cases of PPSFx. We used the unweighted Cohen’s Kappa (κ) for measuring the intra-observer reliability and Krippendorff’s alpha (α) for measuring the inter-observer reliability. The inter-rater reliabilities for the Wright & Cofield and Worland classifications were substantial for all groups. The expert and non-expert groups for UCPF also showed substantial inter-rater agreement. The all-rater group for the UCPF and the expert and non-expert group for the Kirchhoff classification revealed moderate inter-rater reliability. For the Kirchhoff classification, only fair inter-rater reliability was found for the non-expert group. Almost perfect intra-rater reliability was measured for all groups of the Wright & Cofield classification and the all-rater and expert groups of the UCPF. All groups of the Kirchhoff and Worland classifications and the group of non-experts for the UCPF had substantial intra-rater reliabilities. Regarding treatment recommendations, substantial inter-rater and moderate intra-rater reliabilities were found. Simple classification systems for PPSFx (Wright & Cofield, Worland) show the highest inter- and intra-observer reliability but lack comprehensiveness as they fail to describe scapula-sided fractures. The complex Kirchhoff classification shows limited reliability. The UCPF seems to offer an acceptable combination of comprehensiveness and reliability.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inter-Observer and Intra-Observer Reliability Assessment of the Established Classification Systems for Periprosthetic Shoulder Fractures

Wiethölter

Akgün

Plachel

et al. 2023

JCM

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“…In this study, we present a unique successful post-operative surgically treated case utilizing an allogeneic humeral structural bone graft for the management of failed osteosynthesis in a periprosthetic fracture (Wright and Cofield Classification Type C) associated with RTSA [10]. This distinctive case highlights the importance of exploring innovative solutions in the face of challenging orthopedic scenarios.…”

Section: Introductionmentioning

confidence: 97%

The Treatment of Periprosthetic Fracture Revision of the Humerus with “Bamboo Support” Structural Allograft Technique—Atrophic Non-Union of a Post-Operative Periprosthetic Fracture after Reverse Total Shoulder Arthroplasty: A Case Report

Chang,

Lim,

Yoon

et al. 2024

JCM

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Periprosthetic fractures are a serious complication of joint replacement surgery. With the growing prevalence of reverse total shoulder arthroplasty (RTSA), the incidence of relatively uncommon periprosthetic humeral fractures has increased. Here, we present the unique case of a 74-year-old woman who developed atrophic non-union after plate osteosynthesis for a periprosthetic fracture associated with RTSA. Fixation failure was evident 3 months after the surgical intervention; the patient underwent a 3-month course of arm sling immobilization. However, bone resorption continued, and varus angulation of the fracture developed. In this case, surgical strategy involved the use of long proximal humerus internal locked system plate (DePuy Synthes, Paoli, PA, USA), augmented with autologous iliac bone graft and allogenic humerus structural bone graft with the “bamboo support technique”, fixed with Cable System (DePuy Synthes, Paoli, PA, USA). No reports have addressed the management of failed periprosthetic fractures using allogeneic humeral strut bone grafts. This report aims to fill the gap by presenting a novel surgical technique for the management of periprosthetic fractures associated with RTSA in case of treatment failure.

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Reliability of Current Classification Systems for Periprosthetic Fractures of the Humerus

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 2 publications

References 24 publications

Inter-Observer and Intra-Observer Reliability Assessment of the Established Classification Systems for Periprosthetic Shoulder Fractures

Inter-Observer and Intra-Observer Reliability Assessment of the Established Classification Systems for Periprosthetic Shoulder Fractures

The Treatment of Periprosthetic Fracture Revision of the Humerus with “Bamboo Support” Structural Allograft Technique—Atrophic Non-Union of a Post-Operative Periprosthetic Fracture after Reverse Total Shoulder Arthroplasty: A Case Report

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