The Impact of Three-Dimensional CT Imaging on Intraobserver and Interobserver Reliability of Proximal Humeral Fracture Classifications and Treatment Recommendations.

Background: The classification systems for fractures of the proximal part of the humerus provide low interobserver and intraobserver reliability when radiographs or two-dimensional computed tomography scans are used. The purpose of this investigation was to determine whether the use of three-dimensional computed tomography scans could improve interobserver and intraobserver reliability of AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) and Neer classifications and treatment recommendations.

Methods: Two trauma surgeons, one shoulder surgeon, two senior orthopaedic residents, and two junior orthopaedic residents reviewed the radiographs and two and three-dimensional computed tomography scans of forty fractures of the proximal part of the humerus.