INTER/INTRA-OBSERVER EVALUATION BETWEEN RADIOGRAPHS AND TOMOGRAPHIES FOR PROXIMAL HUMERUS FRACTURE

The use of images in 3D reconstruction is an instrument that facilitates the interpretation of the fracture, observations of deviations, rotations and articular surface.

To evaluate the inter-observer and intra-observer reliability of the Neer x AO proximal humerus fracture classification on radiographs versus computed tomography with three-dimensional reconstruction (3D).

We evaluated the digital radiographs (anteroposterior and profile) and computerized tomography with 3D reconstruction of patients presenting with a proximal humerus fracture, surgically treated at an Orthopedics and Traumatology Service. All radiographs and computed tomography were classified (Neer and AO) by eight (8) orthopedic surgeons, specialists in the upper limb and sent, following the pre-established numeration by the author, in a spreadsheet to the author of the study.

The Neer and AO scores were more reproducible when determined by computed tomography with 3D reconstruction, mainly in fractures of greater complexity (Neer 4 parts and AO group C). However, in absolute values, inter and intra-observer reproducibility and concordance still remain low.

Computed tomography with 3D reconstruction allows a better analysis of fractures of group C and Neer 4 parts. However, the inter and intra-observer agreement does not increase significantly in comparison to the radiographs.