The Impact of Three-Dimensional CT Imaging on Intraobserver and Interobserver Reliability of Proximal Humeral Fracture Classifications and Treatment Recommendations

Berkes, Marschall B.; Dines, Joshua S.; Little, Milton T. M.; Garner, Matthew R.; Shifflett, Grant D.; Lazaro, Lionel E.; Wellman, David S.; Dines, David M.; Lorich, Dean G.

doi:10.2106/jbjs.m.00199

Cited by 38 publications

(34 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Extensive effort has been made to improve reliability, including training [3,15], different imaging modalities [2,[16][17][18][19][20]23], and simplifying classification systems [2,24]. Our findings show that the interobserver reliability for the recognition of tibial plateau fracture characteristics on CT scans is higher on MPEG4 videos compared to that on DICOM viewer.…”

Section: Discussionmentioning

confidence: 79%

Online Studies on Variation in Orthopedic Surgery: Computed Tomography in MPEG4 Versus DICOM Format

et al. 2017

View full text Add to dashboard Cite

The purpose of this study was to compare the observer participation and satisfaction as well as interobserver reliability between two online platforms, Science of Variation Group (SOVG) and Traumaplatform Study Collaborative, for the evaluation of complex tibial plateau fractures using computed tomography in MPEG4 and DICOM format. A total of 143 observers started with the online evaluation of 15 complex tibial plateau fractures via either the SOVG or Traumaplatform Study Collaborative websites using MPEG4 videos or a DICOM viewer, respectively. Observers were asked to indicate the absence or presence of four tibial plateau fracture characteristics and to rate their satisfaction with the evaluation as provided by the respective online platforms. The observer participation rate was significantly higher in the SOVG (MPEG4 video) group compared to that in the Traumaplatform Study Collaborative (DICOM viewer) group (75 and 43%, respectively; P < 0.001). The median observer satisfaction with the online evaluation was seven (range, 0-10) using MPEG4 video compared to six (range, 1-9) using DICOM viewer (P = 0.11). The interobserver reliability for recognition of fracture characteristics in complex tibial plateau fractures was higher for the evaluation using MPEG4 video. In conclusion, observer participation and interobserver reliability for the characterization of tibial plateau fractures was greater with MPEG4 videos than with a standard DICOM viewer, while there was no difference in observer satisfaction. Future reliability studies should account for the method of delivering images.

show abstract

Section: Discussionmentioning

confidence: 79%

Online Studies on Variation in Orthopedic Surgery: Computed Tomography in MPEG4 Versus DICOM Format

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Unfortunately, the majority of the studies that explored the opportunity of using CT scans to improve agreement in classification reported no significant results [27,30]. Other authors have reported that the use of 3D-CT scans does not improve the reliability of either the Neer or AO/ OTA classification over traditional CT [31,32]. Given that advanced imaging modalities have not been shown to improve interobserver agreement, we compared the three classification systems using only x-rays.…”

Section: Discussionmentioning

confidence: 98%

Reliability and reproducibility of the new AO/OTA 2018 classification system for proximal humeral fractures: a comparison of three different classification systems

et al. 2020

View full text Add to dashboard Cite

Background: The classification systems for proximal humeral fractures routinely used in clinical practice include the Neer and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 2007 systems. Currently used systems have low inter-and intraobserver reliability. In 2018, AO/OTA introduced a new classification system with the aim of simplifying the coding process, in which the Neer four-part classification was integrated into the fracture description. The aim of the present work is to assess the inter-and intraobserver agreement of the new AO/OTA 2018 compared with the Neer and AO/OTA 2007 classifications. Materials and methods: A total of 116 radiographs of consecutive patients with proximal humeral fracture were selected and classified by three observers with different levels of experience. All three observers independently reviewed and classified the images according to the Neer, AO/OTA 2007, and new AO/OTA 2018 systems. To determine the intraobserver agreement, the observers reviewed the same set of radiographs after an interval of 8 weeks. The inter-and intraobserver agreement were determined through Cohen's kappa coefficient analysis. Results: The new AO/OTA 2018 classification showed substantial mean inter-(k = 0.67) and intraobserver (k = 0.75) agreement. These results are similar to the reliability observed for the Neer classification (interobserver, k = 0.67; intraobserver, k = 0.85) but better than those found for the AO/OTA 2007 system, which showed only moderate inter-(k = 0.57) and intraobserver (k = 0.58) agreement. The two more experienced observers showed better overall agreement, but no statistically significant difference was found. No differences were found between surgical experience and agreement regarding specific fracture types or groups. Conclusions: The results showed that the Neer system still represents the more reliable and reproducible classification. However, the new AO/OTA 2018 classification improved the agreement among observers compared with the AO/OTA 2007 system, while still maintaining substantial descriptive power and simplifying the coding process. The universal modifiers and qualifications, despite their possible complexity, allowed a more comprehensive fracture definition without negatively affecting the reliability or reproducibility of the classification system.

show abstract

“…Assessment of the fracture pattern was independently conducted by a total of 6 orthopedic surgeons, including 3 shoulder surgeons (observers 1–3) and 3 orthopedic trainees, who were young surgeons with less than 4 years of experience as orthopedic surgeons (observers 4–6). The examiners categorized the fractures into 1-part (minimal displacement), 2-part, 3-part, and 4-part fractures by the number of fracture fragments involved, [ 11 , 21 ] but subcategorization of fractures was not assessed in this study. The cases were grouped according to the conventional Neer classification (conventional method) using plain radiographs, and then the CT scans for each case were assessed by each examiner.…”

Section: Methodsmentioning

confidence: 99%

“…Advances in computed tomography (CT) imaging technology have facilitated determining whether fractures have occurred and understanding how the fracture is displaced, and CT is now used frequently to evaluate proximal humeral fractures [ 16 , 17 ]. However, its reproducibility remains in doubt even with the use of CT scans and 3-dimensional computational CT reconstructions [ 14 , 18 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

Reproducibility of the modified Neer classification defining displacement with respect to the humeral head fragment for proximal humeral fractures

et al. 2020

View full text Add to dashboard Cite

Background Although the Neer classification is widely used for the assessment of proximal humeral fractures, its reproducibility has been challenged. The purpose of this study was to evaluate the reproducibility of the conventional Neer classification and a modified classification that defined fracture displacement with respect to the humeral head fragment. Methods The fracture patterns in 80 cases of proximal humeral fractures were independently assessed by 6 observers. The cases were grouped according to the conventional Neer classification using radiographs followed by computed tomography (CT) scans by each examiner twice with a 1-month interval. The fractures were then classified with the modified Neer classification, which defined displacement of the fragment as separation of more than 1 cm or angulation of more than 45° from the humeral head fragment, twice with a 1-month interval. Kappa coefficients of the conventional and modified Neer classifications were compared. Results The modified classification showed significantly higher intra-observer agreement than the conventional classification, both for radiographs (P = .028) and for CT scans (P = .043). Intra-observer agreement was also significantly higher for the modified classification than for the conventional classification, both for radiographs (P = .001) and for CT scans (P < .001). Conclusions The present study showed that agreement for the Neer classification could be improved when fracture displacement was defined as separation or angulation from the humeral head. Considering vascularity to the humeral head, furthermore, the modified method might be more helpful for predicting patients’ prognosis than the conventional Neer classification.

show abstract

The Impact of Three-Dimensional CT Imaging on Intraobserver and Interobserver Reliability of Proximal Humeral Fracture Classifications and Treatment Recommendations

Abstract: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 38 publications

References 27 publications

Online Studies on Variation in Orthopedic Surgery: Computed Tomography in MPEG4 Versus DICOM Format

Online Studies on Variation in Orthopedic Surgery: Computed Tomography in MPEG4 Versus DICOM Format

Reliability and reproducibility of the new AO/OTA 2018 classification system for proximal humeral fractures: a comparison of three different classification systems

Reproducibility of the modified Neer classification defining displacement with respect to the humeral head fragment for proximal humeral fractures

Contact Info

Product

Resources

About