Resch Herbert, Tauber Mark, Neviaser Robert J, Neviaser Andrew S, Majed Addie, Halsey Tim, Hirzinger Corinna, Al-Yassari Ghassan, Zyto Karol, Moroder Philipp
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria.
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria; Department of Shoulder and Elbow Surgery, ATOS Clinic, Munich, Germany.
J Shoulder Elbow Surg. 2016 Mar;25(3):455-62. doi: 10.1016/j.jse.2015.08.006. Epub 2015 Oct 23.
The purpose of this study was to analyze the pathomorphology of proximal humeral fractures to determine relevant and reliable parameters for fracture classification.
A total of 100 consecutive acute proximal humeral fractures in adult patients were analyzed by 2 non-independent observers from a single shoulder department using a standardized protocol based on biplane radiographs and 3-dimensional computed tomography scans. A fracture classification system based on the most reliable key features of the pathomorphologic analysis was created, and its reliability was tested by 6 independent shoulder experts analyzing another 100 consecutive proximal humeral fractures.
The head position in relation to the shaft (varus, valgus, sagittal deformity) and the presence of tuberosity fractures showed a higher interobserver reliability (κ > 0.8) than measurements for medial hinge, shaft, and tuberosity displacement, metaphyseal extension, fracture impaction, as well as head-split component identification (κ < 0.7). These findings were used to classify nondisplaced proximal humeral fractures as type 1, fractures with normal coronal head position but sagittal deformity as type 2, valgus fractures as type 3, varus fractures as type 4, and fracture dislocations as type 5. The fracture type was further combined with the fractured main fragments (G for greater tuberosity, L for lesser). Interobserver and intraobserver reliability analysis for the fracture classification revealed a κ value (95% confidence interval) of 0.700 (0.631-0.767) and 0.917 (0.879-0.943), respectively.
The new classification system with emphasis on the qualitative aspects of proximal humeral fractures showed high reliability when based on a standardized imaging protocol including computed tomography scans.
本研究旨在分析肱骨近端骨折的病理形态学，以确定骨折分类的相关可靠参数。
来自单一肩部科室的2名非独立观察者，使用基于双平面X线片和三维计算机断层扫描的标准化方案，对100例成年患者连续的急性肱骨近端骨折进行分析。基于病理形态学分析中最可靠的关键特征创建了一个骨折分类系统，并由6名独立的肩部专家对另外100例连续的肱骨近端骨折进行分析，以测试其可靠性。
相对于骨干的头部位置（内翻、外翻、矢状面畸形）以及结节骨折的存在，观察者间可靠性高于内侧铰链、骨干和结节移位、干骺端延伸、骨折嵌插以及头劈裂成分识别的测量值（κ>0.8 vs κ<0.7）。这些发现被用于将无移位的肱骨近端骨折分类为1型，冠状位头部位置正常但有矢状面畸形的骨折为2型，外翻骨折为3型，内翻骨折为4型，骨折脱位为5型。骨折类型进一步与骨折主要碎片相结合（G表示大结节，L表示小结节）。骨折分类的观察者间和观察者内可靠性分析显示κ值（95%置信区间）分别为0.700（0.631 - 0.767）和0.917（0.879 - 0.943）。
基于包括计算机断层扫描在内的标准化成像方案，强调肱骨近端骨折定性方面的新分类系统显示出高可靠性。
