August 20, 2014
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3-D CT does not improve interobserver, intraobserver agreement for humerus fractures

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Use of 3-D CT imaging did not offer improved interobserver and intraobserver agreement compared with the use of 2-D CT imaging for the classification and treatment of proximal humerus fractures, according to study results.

Radiographs and 2-D and 3-D CT scans of 40 fractures of the proximal part of the humerus were reviewed in isolation by two trauma surgeons, one should surgeon, two senior orthopedic residents and two junior orthopedic residents. Fractures were classified according to the Neer and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classifications and treatment recommendations were provided.

The researchers repeated the process for intraobserver analysis and calculated interobserver agreement within and between levels of training for each classification and treatment recommendation with respect to radiographs and 2-D and 3-D CT scans.

Study results showed the use of 3-D CT imaging did not improve agreement among attending orthopedic surgeons and senior residents for the Neer classification based on planes, the AO/OTA classification or the treatment recommendation compared with 2-D CT imaging. However, 3-D CT did improve agreement among junior residents. Additionally, 3-D CT also increased agreement for the Neer classification based on planes and for the AO/OTA classification among junior residents and more experienced reviewers when comparing levels of training, but not for treatment recommendation.

Intraobserver agreement for classification and treatment ranged from slight to fair among each reviewer, according to the researchers, but use of 3-D CT did not improve intraobserver agreement.

Disclosure: See the study for a full list of all authors’ relevant financial disclosures.