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

Area of Science:

• Orthopedic surgery
• Radiology
• Medical imaging analysis

Background:

• Proximal humerus fractures are common injuries.
• Accurate classification is crucial for effective treatment.
• Traditional radiographic assessment has limitations in visualizing complex fracture patterns.

Purpose of the Study:

• To compare the reliability of Neer and AO fracture classifications using conventional radiographs versus 3D reconstructed CT scans.
• To evaluate inter-observer and intra-observer agreement for both imaging modalities.

Main Methods:

• Eight orthopedic surgeons classified proximal humerus fractures using digital radiographs and 3D CT reconstructions.
• Fractures were classified according to the Neer and AO systems.
• Inter-observer and intra-observer reliability were assessed.

Main Results:

• 3D CT reconstruction demonstrated higher reproducibility for Neer and AO classifications, particularly for complex fractures (Neer 4-part and AO group C).
• Despite improvements with 3D CT, absolute inter- and intra-observer agreement remained low for both methods.
• 3D CT provided better visualization for complex fracture analysis.

Conclusions:

• 3D CT reconstruction enhances the analysis of complex proximal humerus fractures (AO group C, Neer 4-part).
• While 3D CT offers improved visualization, it does not significantly increase inter- and intra-observer agreement compared to standard radiographs.
• Further research may be needed to improve classification reliability in proximal humerus fractures.