Abstract
BackgroundAlthough the Neer classification is widely used for the assessment of proximal humeral fractures, its reproducibility has been challenged. The purpose of this study was to evaluate the reproducibility of the conventional Neer classification and a modified classification that defined fracture displacement with respect to the humeral head fragment.MethodsThe fracture patterns in 80 cases of proximal humeral fractures were independently assessed by 6 observers. The cases were grouped according to the conventional Neer classification using radiographs followed by computed tomography (CT) scans by each examiner twice with a 1-month interval. The fractures were then classified with the modified Neer classification, which defined displacement of the fragment as separation of more than 1 cm or angulation of more than 45° from the humeral head fragment, twice with a 1-month interval. Kappa coefficients of the conventional and modified Neer classifications were compared.ResultsThe modified classification showed significantly higher intra-observer agreement than the conventional classification, both for radiographs (P = .028) and for CT scans (P = .043). Intra-observer agreement was also significantly higher for the modified classification than for the conventional classification, both for radiographs (P = .001) and for CT scans (P < .001).ConclusionsThe present study showed that agreement for the Neer classification could be improved when fracture displacement was defined as separation or angulation from the humeral head. Considering vascularity to the humeral head, furthermore, the modified method might be more helpful for predicting patients’ prognosis than the conventional Neer classification.
Highlights
Proximal humeral fractures are common injuries in the elderly [1, 2]
The modified classification showed significantly higher intra-observer agreement than the conventional classification for plain radiographs (P = .002) (Table 1)
The modified classification showed significantly higher intra-observer agreement than the conventional classification for computed tomography (CT) scans (P = .013) (Table 1)
Summary
Proximal humeral fractures are common injuries in the elderly [1, 2]. Whereas most of them can be treated nonoperatively, comminuted fractures often require surgical intervention [3]. The concept of the Neer classification is dividing the proximal humerus into 4 segments (humeral head, greater tuberosity, lesser tuberosity, and humeral shaft) and classifying the proximal humeral fractures by the number of displaced segments. The purposes of this 4-segment system were to identify every type of fracture or fracture–dislocation of the proximal humerus, to document the anatomic problems and the therapeutic implications of each category, and to provide terminology that could be used worldwide to depict the pathoanatomy of each entity [9]. The Neer classification is widely used for the assessment of proximal humeral fractures, its reproducibility has been challenged. The purpose of this study was to evaluate the reproducibility of the conventional Neer classification and a modified classification that defined fracture displacement with respect to the humeral head fragment
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