The radiographs of 95 fractures of the proximal end of the humerus were classified with the Neer and the AO/ASIF systems by 5 orthopaedic surgeons who had a special interest in problems of the shoulder. Without access to their initial interpretations, the same 5 orthopaedic surgeons reevaluated the same radiographs 8 weeks later. Intraobserver and intraobserver reliability were found to be fair or poor for both classification systems. Kappa values for the interobserver reliability were 0.40 for the Neer system and 0.53 for the AO/ASIF system. When the fractures were subclassified, according to the recommendations of the AO/ASIF, into groups and subgroups, reproducibility became progressively worse. Intraobserver reliability showed kappa values of 0.60 and 0.58, respectively. A so-called extended radiographic trauma series, consisting of 3 perpendicular radiographs, was available for 35 fractures; the third perpendicular projection did not significantly improve the reproducibility values for either classification compared with those obtained with only 2 perpendicular projections. We concluded that neither the Neer nor the AO/ASIF classification of fractures of the proximal end of the humerus is sufficiently reproducible to allow meaningful comparison of similarly classified fractures in different studies.
Copyright remains with the authors and publisher.
The radiographs of 95 fractures of the proximal end of the humerus were classified with the Neer and the AO/ASIF systems by 5 orthopaedic surgeons who had a special interest in problems of the shoulder. Without access to their initial interpretations, the same 5 orthopaedic surgeons reevaluated the same radiographs 8 weeks later. Intraobserver and intraobserver reliability were found to be fair or poor for both classification systems. Kappa values for the interobserver reliability were 0.40 for the Neer system and 0.53 for the AO/ASIF system. When the fractures were subclassified, according to the recommendations of the AO/ASIF, into groups and subgroups, reproducibility became progressively worse. Intraobserver reliability showed kappa values of 0.60 and 0.58, respectively. A so-called extended radiographic trauma series, consisting of 3 perpendicular radiographs, was available for 35 fractures; the third perpendicular projection did not significantly improve the reproducibility values for either classification compared with those obtained with only 2 perpendicular projections. We concluded that neither the Neer nor the AO/ASIF classification of fractures of the proximal end of the humerus is sufficiently reproducible to allow meaningful comparison of similarly classified fractures in different studies.
Copyright remains with the authors and publisher.