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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 6, 766-771.
doi: 10.1302/0301-620X.91B6.22109  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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The impact of stereo-visualisation of three-dimensional CT datasets on the inter- and intraobserver reliability of the AO/OTA and Neer classifications in the assessment of fractures of the proximal humerus

A. Brunner, MD, Trauma Surgery Resident1; P. Honigmann, MD, Trauma Surgery Resident1; T. Treumann, MD, Radiologist2; and R. Babst, MD, Professor1

1 Department of Trauma Surgery
2 Department of Radiology Cantonal Hospital, Spitalstrasse 42, 6000 Lucerne 16, Switzerland.

Correspondence should be sent to Dr A. Brunner; e-mail: a-r.brunner{at}web.de

We evaluated the impact of stereo-visualisation of three-dimensional volume-rendering CT datasets on the inter- and intraobserver reliability assessed by kappa values on the AO/OTA and Neer classifications in the assessment of proximal humeral fractures. Four independent observers classified 40 fractures according to the AO/OTA and Neer classifications using plain radiographs, two-dimensional CT scans and with stereo-visualised three-dimensional volume-rendering reconstructions. Both classification systems showed moderate interobserver reliability with plain radiographs and two-dimensional CT scans. Three-dimensional volume-rendered CT scans improved the interobserver reliability of both systems to good. Intraobserver reliability was moderate for both classifications when assessed by plain radiographs. Stereo visualisation of three-dimensional volume rendering improved intraobserver reliability to good for the AO/OTA method and to excellent for the Neer classification.

These data support our opinion that stereo visualisation of three-dimensional volume-rendering datasets is of value when analysing and classifying complex fractures of the proximal humerus.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General