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Interobserver variability of three radiographic classifications for proximal humerus fracture among orthopedic residents at the ABC Medical Center
Interobserver variability of three radiographic classifications for proximal humerus fracture among orthopedic residents at the ABC Medical Center
Daniela del Río-González 1 
, Eira Santiago-Balmaseda 1 , Luis Ochoa-Olvera 1 , Carlos F. Gutiérrez-Toledano 1 , Jorge A. Ascencio-Aragón 1 , Alejandro G. Gallegos-Tejeda 1
1 Servicio de Traumatología y Ortopedia, Centro Médico ABC, Ciudad de México, México
*Correspondence: Daniela del Río-González. Email: danieladr.gonzalez@gmail.com
Abstract
Background: Currently, the reproducibility and reliability of radiological classifications for proximal humerus fractures have not been demonstrated. Despite the widespread use of the Neer classification, it exhibits high interobserver variability.
Objective: To assess interobserver variability of three radiographic classifications for proximal humerus fractures (Neer, Hertel, and Mayo-FJD) among orthopedic residents at Centro Médico ABC.
Method: Four observers evaluated 100 anteroposterior radiographs of proximal humerus fractures, assigning a grade based on Neer, Hertel, and Mayo-FJD classifications. Interobserver agreement was measured using the kappa correlation coefficient.
Results: Of the total radiographs, 70% were from female patients and 30% from male patients, with an average age of 67 years. The Neer classification showed the highest interobserver agreement (0.350). Hertel classification had an agreement of 0.265, and Mayo-FJD classification showed an agreement of 0.345, with the latter being more consistent among higher-ranking residents.
Conclusions: The evaluated classifications lack reliability in describing proximal humerus fractures in anteroposterior shoulder radiographs. It is recommended to assess the reliability of these classifications for computed tomography studies.
Keywords: Classification. Proximal humerus. Fracture.
