Evans' classification of trochanteric fractures: an assessment of the interobserver and intraobserver reliability

The reliability of Evans' classification of trochanteric femoral fractures was examined using κ (Kappa) statistics. Radiographs of 50 randomly chosen trochanteric fractures were evaluated by six observers. One set of radiographs was uniformly classified as a subtrochanteric fracture by all observers and was excluded from further analysis.

Only 18 per cent of the fractures were classified identical by all observers and 57 per cent when differentiating between stable and unstable fractures. The corresponding κ values showed moderate agreement ranging from 0.38 to 0.68     

Letournel classification for acetabular fractures. Assessment of interobserver and intraobserver reliability

BACKGROUND: A fracture classification system enables communication among surgeons and provides guidelines for treatment as well as some estimate of prognosis. Thus, the system should be anatomically meaningful and reliable. The purpose of this study was to assess the interobserver and intraobserver reliability of Letournel's acetabular fracture classification and the effect of computed tomography on its reliability. METHODS: Plain radiographs (anteroposterior and Judet views) and axial computed tomography scans were randomly chosen from an acetabular fracture database, with at least five cases of each fracture type and eight of the most common types. The study involved three groups of three orthopaedic surgeons: (1) surgeons who had studied under Letournel, (2) surgeons who specialized in acetabular fracture surgery, and (3) general trauma surgeons. Each observer read the radiographs twice, and at each session the fractures were classified first on the basis of the radiographs only and then in combination with the computed tomography scan. Observer agreement was then assessed with the unweighted kappa coefficient (kappa). We also calculated the frequency with which the observers agreed with the diagnosis made intraoperatively by the treating orthopaedic surgeon. RESULTS: The interobserver reliability without and with computed tomography during the first session was 0.70 and 0.74, respectively, for group 1, 0.71 and 0.69 for group 2, and 0.51 and 0.51 for group 3. The results of the second session were similar. When the two sessions were compared, intraobserver reliability without and with computed tomography was 0.80 and 0.83 for group 1, 0.80 and 0.80 for group 2, and 0.64 and 0.69 for group 3. The overall agreement of the radiographic observation with the fracture pattern observed at surgery was 74%. CONCLUSIONS: Letournel's acetabular classification with use of plain radiographs with or without supplemental computed tomography scans has substantial reliability (kappa > 0.7) when used by surgeons who have been taught how to interpret the images or by those who treat acetabular fractures on a regular basis. The value of computed tomography scans in the evaluation of acetabular fractures has been well established for the identification of loose bodies and articular impaction; however, they do not appear to be essential for the classification of acetabular fractures.     

Epidemiology of proximal humeral fractures

In an urban population of half a million, all proximal humeral fractures were recorded in 1983. A total of 565 fractures, of which 77 per cent occurred in women, were seen. The overall incidence per 100,000 was 48 in men and 142 in women, with an exponential increase from the 5th decade of age. This rise was due to a higher incidence of minimally displaced fractures associated with moderate trauma, and thus of fractures associated with osteoporosis.     

Epidemiology of proximal humeral fractures

In an urban population of half a million, all proximal humeral fractures were recorded in 1983. A total of 565 fractures, of which 77 per cent occurred in women, were seen. The overall incidence per 100,000 was 48 in men and 142 in women, with an exponential increase from the 5th decade of age. This rise was due to a higher incidence of minimally displaced fractures associated with moderate trauma, and thus of fractures associated with osteoporosis.     

Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: A prospective study

Background  

A precise modular topographic-morphological (MTM) classification for proximal humeral fractures may address current classification problems. The classification was developed to evaluate whether a very detailed classification exceeding the analysis of fractured parts may be a valuable tool.     

肱骨近端内锁定系统治疗肱骨近端骨折

目的探讨肱骨近端内锁定系统（PHILOS）治疗肱骨近端骨折的疗效。方法对21例肱骨近端骨折患者采用三角肌、胸大肌间沟入路,保护附着于大骨折块和大、小结节上的软组织,骨折复位后均行PHILOS内固定。患肩功能按Constant-Murley肩关节评分系统进行评价。结果患者均获随访,时间9～21（16±5.3）个月。骨折均愈合,时间2.5～3.5（3±0.7）个月。末次随访时患侧肩关节评分为75～95（85.5±5.6）分。优10例,良9例,可2例。结论 PHILOS可牢固固定骨折,骨折愈合与功能恢复相同步,提高了疗效,适用于粉碎性骨折和肱骨近端骨质疏松骨折的治疗。     

肱骨近端锁定接骨板治疗肱骨近端复杂性骨折的回顾性分析

目的探讨肱骨近端锁定接骨板（locking proximal humeral plate,LPHP）治疗肱骨近端复杂性骨折的临床疗效。方法对2005年1月至2008年10月在我院行LPHP治疗并获得随访的31例复杂性患者进行回顾性分析,从患者年龄、受伤机制、骨折类型、手术时机、骨折复位质量、术后康复方法、内固定取出时间对肩关节功能影响进行评估。结果31例患者获得10-56个月的随访,平均26．5个月。按Neer分型标准：三部分骨折13例,四部分骨折18例。肩关节功能按照constant评分,平均81．3分,其中优13例,良12例,可3例,差3例,优良率80．6％。按照Logistic回归分析,不同骨折类型、手术时机、复位质量及术后康复方法对肩关节功能产生不同影响,差异有统计学意义（P〈0．05）,而患者不同年龄、受伤机制和内固定取出时间对肩关节功能影响差异无统计学意义（P〉0．05）。结论LPHP治疗肱骨近端复杂骨折具有良好的疗效。在保护骨折端血运的前提下尽可能地解剖复位、妥善固定,合理处理大、小结节是获得良好手术疗效的关键。术后早期、积极、正确的康复锻炼是获得良好手术疗效的重要条件。     

Four-segment classification of proximal humeral fractures revisited: A multicenter study on 509 cases

The revised Neer classification covers 98% of all proximal humeral fractures, and it would be appropriate to use this classification in clinical practice. When there are 3 displaced segments, close attention should be paid to the fracture line on the anatomic neck. If the fracture spans the full length of the anatomic neck, it is not included in the revised Neer classification, but such a fracture is equivalent to a 4-part fracture in terms of the risk of humeral head necrosis.     

Periprosthetic humeral fractures: management and classification

Six patients (67 to 94 years of age) sustained a periprosthetic humeral fracture at an average of 43 months after shoulder arthroplasty (range 13 to 85 months). These fractures were classified depending on fracture anatomy and implant stability. Type A fractures occur about the tuberosities. Type B fractures occur about the stem and are subclassified by fracture anatomy and implant stability: B1 fractures are spiral fractures with a stable implant, B2 fractures are transverse or short oblique fractures about the tip of the stem with a stable implant, and B3 fractures are those fractures about the stem with an unstable implant. Type C fractures occur well distal to the tip of the stem. Five of the 6 fractures required surgery, 4 with revision to a long-stemmed component. All fractures united with restoration of range of motion and function. Satisfactory results may be anticipated if these fractures are managed in an appropriate fashion.     

Radiographic assessment of pediatric proximal radius fractures: interrater and intrarater reliability

Three methods of measuring pediatric proximal radius fracture radiographs were compared using injury films of 32 patients. Angulation and displacement were independently measured by four physicians. One physician measured the films by each method a second time 2 months later. Values for interrater and intrarater reliability were determined using inter- and intra-class coefficients (ICC). Interrater reliability was poor for methods using the axis of the proximal radial fragment or the proximal radial physis as a reference (ICC = 0.47 and 0.42, respectively). Measurement of the angle between a line parallel to the proximal radius articular surface and the radial shaft had the highest interrater reliability (0.76); measurement of displacement had the lowest interrater reliability (0.09). The intrarater reliability was excellent for all methods (0.93-0.99) and was also highest when the proximal articular surface reference was used. Of described methods, use of the proximal radius articular surface and the radial shaft as references had the highest interrater and intrarater reliability.     

Minimally displaced proximal humeral fractures

We analyzed 507 consecutive minimally displaced proximal humeral fractures and showed that, if the AO classification is used, there is variation in the incidence of minimally displaced fractures in the different AO sub-groups. Patients with Type A minimally displaced fractures are significantly younger than those with Type B or C fractures. 376 patients were followed for 1 year and 88% achieved excellent or good results with nonoperative management. Age was the main determinant of outcome, according to the Neer score and the time taken to return to activities of daily living. Subjectively, older patients felt that the results of treatment were better than the objective measurement of gleno-humeral function would indicate. Many patients with fair or poor results had co-morbidities that prevented a good result. The length of the physiotherapy course affected the outcome at 1 year.     

肱骨近端锁定钢板治疗肱骨近端粉碎性骨折

目的评价肱骨近端锁定钢板（LPHP）治疗肱骨粉碎性骨折的治疗效果。方法2004年6月～2007年12月应用肱骨近端锁定钢板治疗肱骨近端骨折32例,男14例、女18例,年龄23～85岁,平均57．1±5．8岁。根据Neer分型：二部分骨折6例,三部分骨折21例,四部分骨折5例。术后利用Constant评分评价其治疗效果。结果随诊10个月～3．5年,平均2．1±0．8年,4例失访,随访期末均顺利愈合。1例出现肱骨头部分坏死,但不影响功能;3例出现肩关节半脱位;2例保守治疗缓解;1例出现肩关节撞击征。根据Constant评分为优良率89．2％（25／28）。结论肱骨近端锁定钢板（LPHP）是治疗肱骨近端粉碎性骨折的首选方法之一．可取得较好的临床治疗结果。     

肱骨近端骨折的手术治疗

目的 探讨肱骨近端骨折的外科治疗。方法 48例肱骨近端骨折，其中保守治疗失败的NeerⅡ型骨折8例、NeerⅢ型骨折26例、NeerⅣ型骨折14例，均采用手术治疗，分别行开放复位、肱骨近端解剖型钢板内固定(38例)和肱骨头假体置换术(10例)。术后按美国肩肘关节医师学会肩关节评分系统进行疗效评价。结果 所有病例均获随访，时间为9～24个月。患肩无明显疼痛，患肩关节上举、内旋、外旋，完成五项日常生活能力，总体恢复满意。结论 对保守治疗失败的NeerⅡ型骨折、NeerⅢ、Ⅳ型骨折应采取手术治疗，而NeerIV型骨折以假体置换术为佳。