tailieunhanh - báo cáo hóa học:" Classification and treatment of proximal humerus fractures: inter-observer reliability and agreement across imaging modalities and experience"

Tuyển tập các báo cáo nghiên cứu về hóa học được đăng trên tạp chí sinh học quốc tế đề tài : Classification and treatment of proximal humerus fractures: inter-observer reliability and agreement across imaging modalities and experience | Foroohar et al. Journal of Orthopaedic Surgery and Research 2011 6 38 http content 6 1 38 JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH RESEARCH ARTICLE Open Access Classification and treatment of proximal humerus fractures inter-observer reliability and agreement across imaging modalities and experience 11 1 2 3 Abtin Foroohar Rick Tosti John M Richmond John P Gaughan and Asif M Ilyas Abstract Summary Proximal humerus fractures PHF are common injuries but previous studies have documented poor inter-observer reliability in fracture classification. This disparity has been attributed to multiple variables including poor imaging studies and inadequate surgeon experience. The purpose of this study is to evaluate whether interobserver agreement can be improved with the application of multiple imaging modalities including X-ray CT and 3D CT reconstructions stratified by physician experience for both classification and treatment of PHFs. Methods Inter-observer agreement was measured for classification and treatment of PHFs. A total of sixteen fractures were imaged by plain X-ray scapular AP and lateral CT scan and 3D CT reconstruction yielding 48 randomized image sets. The observers consisted of 16 orthopaedic surgeons 4 upper extremity specialists 4 general orthopedists 4 senior residents 4 junior residents who were asked to classify each image set using the Neer system and recommend treatment from four pre-selected choices. The results were evaluated by kappa reliability coefficients for inter-observer agreement between all imaging modalities and sub-divided by fracture type and observer experience. Results All kappa values ranged from slight to moderate k .03 to .57 agreement. For overall classification and treatment no advanced imaging modality had significantly higher scores than X-ray. However when subdivided by experience 3D reconstruction and CT scan both had significantly higher agreement on classification than X-ray among upper extremity .