Jawa Andrew, Yi Paul H, Boykin Robert E, Gardner Michael J, Gerber Christian, Lorich Dean G, Walch Gilles, Warner Jon J P
University of California San Francisco, San Francisco, CA.
Am J Orthop (Belle Mead NJ). 2015 Feb;44(2):77-81.
Surgeons' disagreement about ideal treatment for proximal humerus fractures (PHFs) may reflect a difference in training. We conducted a study to compare treatment decision-making by experienced shoulder and trauma fellowship--trained surgeons. Two expert shoulder surgeons and 2 expert trauma surgeons reviewed 100 consecutive PHFs surgically treated at another institution. Using available imaging, the examiners assigned scores for agreement with treatment decisions and for ratings of reduction/arthroplasty placement, fixation method, and radiographic outcomes. The scores were evaluated for interobserver reliability using intraclass correlation coefficients. Overall, these experienced surgeons agreed poorly with treatment decisions and fixation methods but agreed moderately on acceptable reductions/arthroplasty placement and final radiographic outcomes. Agreement on the final radiographic outcomes was more uniform and acceptable for both shoulder and trauma surgeons. Trauma surgeons agreed more with each other about treatment decisions than shoulder surgeons agreed with each other. In this study, surgeon disagreement and an aging population highlight the need for better evidence regarding optimal treatment for PHFs in order to improve consensus.
外科医生对于肱骨近端骨折（PHFs）理想治疗方法的分歧可能反映出培训方面的差异。我们开展了一项研究，以比较接受过肩部和创伤专科培训的经验丰富的外科医生在治疗决策上的差异。两位肩部专家外科医生和两位创伤专家外科医生回顾了在另一机构接受手术治疗的100例连续的PHFs病例。检查人员利用现有的影像学资料，为与治疗决策的一致性以及复位/关节成形术置入、固定方法和影像学结果评分。使用组内相关系数评估评分的观察者间可靠性。总体而言，这些经验丰富的外科医生在治疗决策和固定方法上的一致性较差，但在可接受的复位/关节成形术置入和最终影像学结果上有适度的一致性。对于最终影像学结果的一致性，肩部和创伤外科医生都更为一致且可接受。创伤外科医生在治疗决策上彼此之间的意见比肩部外科医生彼此之间更为一致。在这项研究中，外科医生的分歧以及人口老龄化凸显了需要有更好的关于PHFs最佳治疗的证据，以提高共识。
