AST classification of proximal humeral fractures: introduction and interobserver reliability assessment
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This article introduces an alphanumeric AST (Articular, Surgical neck, Tuberosities) classification of proximal humeral fractures, based on the number, localization, and displacement of articular and extra-articular fragments. All possible cases of proximal humeral fractures can be assessed from a single figure using this classification. The aim of the study was thus to describe the AST classification and to assess interobserver reliability.
This classification is based on a single figure, allowing an easy description of the anatomic variants of different proximal humeral fractures. The severity of the fracture is determined by the fragment displacement in angular degrees and the major linear displacement in millimeters. AST reproducibility was assessed and compared with Neer, AO, and Duparc classifications, commonly used in clinical practice. The interobserver agreement was measured with Cohen’s kappa coefficients and their 95% confidence intervals.
Thirteen independent observers analyzed a total of 64 X-rays. Overall kappa coefficients were 0.34, 0.29, 0.24, and 0.25 for AST, Neer, AO, and Duparc classifications, respectively.
The AST classification, which is easier to use because it is based on only one figure, is at least as reproducible as other proximal humeral fracture classifications.
KeywordsProximal humeral fractures Classification Interobserver reliability
We would like to thank the physicians who participated in this study for their extraordinary help, and for the reading, classification, and analysis of four different classifications of a total of 64 X-rays of proximal humeral fractures: Dr Beau—Metz, Dr Berrichi—Metz, Dr Boughrebi—Amiens, Dr Camus—Dunkerque, Dr Dujardin—Orléans, Dr Favreul—Lyon, Pr Galois—Nancy, Dr Ionescu—Metz, Dr Irrazi—Metz, Dr Kany—Toulouse, Dr Khalife—Metz, Pr Roussignol—Rouen, Dr Schenk—Strasbourg, Dr Schwartz—Colmar, Dr Scarlat—Toulon, Dr Seboiu—Metz, Pr Simon—Lyon, Dr Travers—Lyon, as well as the talented Mrs L. Collette—Bruxelles, for the figures.
Conflict of interest
The authors have no conflict of interest to declare.
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