Department of Trauma and Orthopaedics,New Cross Hospital, Wolverhampton, West Midlands, UK.
Injury. 2011 Apr;42(4):339-42. doi: 10.1016/j.injury.2010.02.002. Epub 2010 Mar 4.
We investigated if the introduction of digital radiography, with its software permitting enhancement of plain radiographs, improved inter- and intra-observer agreement in the Neer classification.
Five observers participated in classifying 50 randomly selected radiographs with a confirmed proximal humeral fracture. The observers included a junior registrar, an upper-limb fellow, a lower-limb orthopaedic consultant and two orthopaedic shoulder consultants. Agreement was quantified via kappa values.
In general, good (0.61-0.80) results were obtained using kappa value for inter-observer reliability throughout all grades. On further analysis, however, discrepancies persist in the classification between Neer type 1/2 and Neer type 5 categories. The latter was not restricted to more inexperienced surgeons. Intra-observer agreement (> 0.81) was excellent throughout all grades.
The introduction of digital radiography aids the improvement of Neer classification of proximal humeral fractures across all grades. With superior agreement in displacement and fracture patterns, improved communication and discussion of these injuries and similar treatment plans can be expected. This may help negate one aspect of the variability in outcome of proximal humeral shaft fractures. More complex fracture configurations continue to have difficulty in interpretation and may require further imaging analysis to conclude definitively.
我们研究了数字化摄影的引入，及其允许增强普通射线照片的软件，是否能提高 Neer 分类中观察者间和观察者内的一致性。
5 名观察者参与了对 50 张随机选择的、经证实有肱骨近端骨折的射线照片的分类。观察者包括一名初级住院医师、一名上肢研究员、一名下肢矫形顾问和两名矫形肩部顾问。通过kappa 值来量化一致性。
总体而言，在所有等级中，kappa 值用于观察者间可靠性的结果均为良好（0.61-0.80）。然而，进一步分析显示，在 Neer 1/2 型和 Neer 5 型分类之间仍然存在分类差异。后者不仅限于经验较少的外科医生。在所有等级中，观察者内一致性（>0.81）均非常出色。
数字化射线摄影的引入有助于提高所有等级的肱骨近端骨折的 Neer 分类。由于在移位和骨折模式方面具有更高的一致性，可以预期这些损伤的沟通和讨论以及类似的治疗计划将会得到改善。这可能有助于消除肱骨近端干骨折结果变异性的一个方面。更复杂的骨折构型在解释上仍存在困难，可能需要进一步的成像分析来得出明确的结论。
