Classification and treatment of proximal humerus fractures: inter-observer reliability and agreement across imaging modalities and experience

This report has been verified by one or more authors of the original publication.

16 proximal humerus fractures were imaged by X-ray, CT scan, and 3D CT reconstruction to make 48 randomized image sets.16 orthopaedic surgeons (4 upper extremity specialists, 4 general orthopedists, 4 senior residents, 4 junior residents) were asked to classify each image set using the Neer system, and recommend a treatment to study inter-observer agreement and stratification by physician experience. All kappa values were low ranging from “slight” to “moderate” agreement. Overall classification and treatment, was highest in X-ray. However, 3D reconstruction showed a slight improvement in the fracture classification among specialized upper extremity surgeons compared to all imaging modalities, fracture types, and surgeon experience.