ArticlePatient safety in surgery2019
Inter-observer reliability of alternative diagnostic methods for proximal humerus fractures: a comparison between attending surgeons and orthopedic residents in training.
Article in Patient safety in surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 21 citations in OpenAlex.
- A Novel Radiographic Classification of the Proximal Tibiofibular Joint.Medicina (Kaunas, Lithuania) · 2026Article
- A Comprehensive Review of 3D Imaging and Printing in Proximal Humerus Fractures and Sequelae.Journal of clinical medicine · 2025Review
- Three-dimensional printed models can reduce costs and surgical time for complex proximal humeral fractures: preoperative planning, patient satisfaction, and improved resident skills.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2024Article
- Morphology and novel classification of proximal humeral fractures.Frontiers in bioengineering and biotechnology · 2024Article
- The role of 3-dimensional printed models in the management of the distal radius fractures.Acta orthopaedica et traumatologica turcica · 2023Article
- FACTORS ASSOCIATED WITH THE OUTCOMES OF OLDER PATIENTS OPERATED DUE TO HIP FRACTURES.Acta ortopedica brasileira · 2023Article
- Inter-rater agreement on proximal humerus fracture treatment in Korea.Clinics in shoulder and elbow · 2022Article
- Three-dimensional printing models increase inter-rater agreement for classification and treatment of proximal humerus fractures.Patient safety in surgery · 2022Article
- INTRA- AND INTER-OBSERVER AGREEMENT OF PROXIMAL HUMERAL FRACTURES CLASSIFICATIONS IN ADULTS.Acta ortopedica brasileira · 2022Article
- Reliability and reproducibility of the new AO/OTA 2018 classification system for proximal humeral fractures: a comparison of three different classification systems.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2020Article
- Three-dimensional models increase the interobserver agreement for the treatment of proximal humerus fractures.Patient safety in surgery · 2020Article
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundProximal humerus fractures are frequent, and several studies show low diagnostic agreement among the observers, as well as an inaccurate classification of these lesions. The divergences are generally correlated with the experience of the surgeons as well as the diagnostic methods used. This paper challenges these problems including alternative diagnostic methods such as 3D models and augmented reality (holography) and including the observers' period of medical experience as a factor.
methodsTwenty orthopedists (ten experts in shoulder surgery and ten experts in traumatology) and thirty resident physicians in orthopedics classified nine proximal humerus fractures randomly distributed as x-ray, tomographies, 3D models and holography, using AO/ASIF and Neer's classification. In the end, we evaluated the intra- and inter-observer agreement between diagnostic methods and whether the experience of the observers interfered in the evaluations and the classifications used.
resultsWe found overall kappa coefficients ranging from 0.241 (fair) to 0.624 (substantial) between the two classifications (AO / ASIF and Neer), concerning the diagnostic methods used. We identified image modality differences (
conclusions3D models can substantially improve diagnostic agreement for proximal humerus fractures evaluation among experts or resident physicians. The holography showed good agreement between the experts and can be a similar option to x-ray and tomography in the evaluation and classification of these fractures. The observers' period of experience did not improve the diagnostic agreement between the image modalities studied.
trial registrationRegistered in the Brazil Platform under no. CAAE 88912318.1.0000.5487.
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