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Interobserver agreement of Neer and AO classifications for proximal humeral fractures

Papakonstantinou, Martisa K., Hart, Melissa J., Farrugia, Richard, Gabbe, Belinda J., Moaveni, Afshin Kamali, van Bavel, Dirk, Page, Richard S. and Richardson, Martin D. 2016, Interobserver agreement of Neer and AO classifications for proximal humeral fractures, ANZ journal of surgery, vol. 86, no. 4, pp. 280-284, doi: 10.1111/ans.13451.

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Title Interobserver agreement of Neer and AO classifications for proximal humeral fractures
Author(s) Papakonstantinou, Martisa K.
Hart, Melissa J.
Farrugia, Richard
Gabbe, Belinda J.
Moaveni, Afshin Kamali
van Bavel, Dirk
Page, Richard S.ORCID iD for Page, Richard S. orcid.org/0000-0002-2225-7144
Richardson, Martin D.
Journal name ANZ journal of surgery
Volume number 86
Issue number 4
Start page 280
End page 284
Total pages 5
Publisher Wiley-Blackwell
Place of publication Milton, Qld.
Publication date 2016-04
ISSN 1445-1433
1445-2197
Keyword(s) X-rays
classification
humerus
observer variation
shoulder fractures
Summary BACKGROUND:The classification of proximal humeral fractures remains challenging. The two main classification systems used, the Neer and the AO classification, have both been shown to have less than ideal interobserver agreement. Agreement in classification is required, however, to guide fracture management.

METHOD:Data from the Victorian Orthopaedic Trauma Outcomes Registry were collected and the X-rays of 104 proximal humeral fractures were reviewed by three orthopaedic consultants. They classified the fractures according to the Neer and AO classifications, as well as their simplified versions. Interobserver agreement was then assessed using kappa statistics.

RESULTS:Interobserver agreement was better overall in the Neer classification, which was moderate (kappa = 0.40-0.58), than the AO classification, which was fair to moderate (kappa = 0.31-0.54). When simplified, the Neer and AO classification interobserver agreement remained similar.

CONCLUSION:The classification of proximal humeral fractures with both the Neer and the AO systems remains difficult with minimal improvements seen when reducing the number of categories in each classification system. From these results, the Neer classification system would appear slightly more useful in clinical practice to guide treatment.
Language eng
DOI 10.1111/ans.13451
Field of Research 110399 Clinical Sciences not elsewhere classified
110314 Orthopaedics
1103 Clinical Sciences
Socio Economic Objective 920116 Skeletal System and Disorders (incl. Arthritis)
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, Royal Australasian College of Surgeons
Persistent URL http://hdl.handle.net/10536/DRO/DU:30082320

Document type: Journal Article
Collections: School of Medicine
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.