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Pathomorphologic analysis of proximal humeral fractures had high reliability
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When based on a standardized imaging protocol including CT scans, recently published results showed high reliability in a new classification system with emphasis on the qualitative aspects of proximal humeral fractures.
Using a standardized protocol based on biplane radiographs and 3-D CT scans, two non-independent observers analyzed 100 consecutive acute proximal humeral fractures in adult patients. Researchers created a fracture classification system based on the most reliable key features of the pathomorphologic analysis, which was tested on another 100 consecutive proximal humeral fractures by six independent shoulder experts.
Philipp Moroder
Compared with measurements for medial hinge, shaft and tuberosity displacement; metaphyseal extension; fracture impaction and head-split component identification, results showed higher interobserver reliability in the head position in relation to the shaft and the presence of tuberosity fractures. Researchers used these findings to classify nondisplaced proximal humeral fractures as type 1, fractures with normal coronal head position but sagittal deformity as type 2, valgus fractures as type 3, varus fractures as type 4 and fracture dislocations at type 5, according to results. Researchers further combined the fracture type with the fractured main fragments, and found kappa values of 0.700 for interobserver reliability and 0.917 for intraobserver reliability. – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.
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