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

J Bone Joint Surg Br. 2009 Jun;91(6):766-71. doi: 10.1302/0301-620X.91B6.22109.

Abstract

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.

Publication types

  • Evaluation Study

MeSH terms

  • Female
  • Humans
  • Imaging, Three-Dimensional / methods*
  • Male
  • Observer Variation
  • Reproducibility of Results
  • Retrospective Studies
  • Shoulder Fractures / classification
  • Shoulder Fractures / diagnostic imaging*
  • Tomography, X-Ray Computed / methods*