Ismayl Ghiath, Ogbechie Catherine, Goundry Samuel, Budworth Luke, Ejiofor Ikechukwu, Sheikh Hassaan, McCormack Paul, Tunstall Charlotte, Philipson Mark, Cowling Paul
Trauma and Orthopaedics Department, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK.
University of Leeds, Leeds, UK.
Shoulder Elbow. 2025 Jan;17(1):50-56. doi: 10.1177/17585732241248835. Epub 2024 Apr 24.
Literature demonstrates variability in the amount of displacement of isolated greater tuberosity (GT) fractures and measurement techniques that orthopaedic surgeons deem warrant surgical intervention. This study aims to assess the intra and interobserver reliability for classifying and measuring the displacement amount for isolated GT fractures.
Eight surgeons, consisting of four shoulder specialists and four trainee surgeons, reviewed 25 plain radiographs on two separate occasions, 3 months apart. They were required to morphologically classify the GT fracture, measure the displacement distance on anteroposterior and axillary views, calculate the GT displacement ratio, and state whether they would offer surgical treatment.
There was a lack of good reliability for the classification of the depression and avulsion fracture types. There was good intraobserver but poor interobserver consistency in classifying the split-type fractures. The measurement of the displacement distance showed good intraobserver reliability, but not as good interobserver agreement. Also, the displacement ratio calculated revealed poor consistency. We found good agreement between and within the raters for the treatment decision. No significant difference was noted when comparing the senior surgeons to the junior surgeons.
This study has revealed ongoing inconsistency in the classification and measurement of isolated GT fractures.
文献表明，孤立性大结节（GT）骨折的移位量以及骨科医生认为需要手术干预的测量技术存在差异。本研究旨在评估对孤立性GT骨折进行分类和测量移位量时观察者内和观察者间的可靠性。
八名外科医生，包括四名肩部专科医生和四名实习外科医生，在相隔3个月的两个不同时间点查看了25张普通X线片。他们需要对GT骨折进行形态学分类，在前后位和腋位片上测量移位距离，计算GT移位率，并说明是否会提供手术治疗。
对于凹陷型和撕脱型骨折的分类，缺乏良好的可靠性。在对劈裂型骨折进行分类时，观察者内一致性良好，但观察者间一致性较差。移位距离的测量显示观察者内可靠性良好，但观察者间一致性不佳。此外，计算出的移位率一致性较差。我们发现评估者之间以及评估者内部对于治疗决策的意见一致。将资深外科医生与初级外科医生进行比较时，未发现显著差异。
本研究揭示了孤立性GT骨折在分类和测量方面仍存在不一致性。
