AST classification of proximal humeral fractures: introduction and interobserver reliability assessment

  • Christian Cuny
  • Cedric Baumann
  • Julien Mayer
  • Didier Guignand
  • M’barek Irrazi
  • Aboubekr Berrichi
  • Nicolas Ionescu
  • Francis Guillemin
Original Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Proximal humeral fractures Classification Interobserver reliability 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Christian Cuny
    • 1
  • Cedric Baumann
    • 2
  • Julien Mayer
    • 1
  • Didier Guignand
    • 1
  • M’barek Irrazi
    • 1
  • Aboubekr Berrichi
    • 1
  • Nicolas Ionescu
    • 1
  • Francis Guillemin
    • 2
  1. 1.Department of Orthopaedics and TraumatologyCHR Metz Bon-SecoursMetz CedexFrance
  2. 2.Department of Clinical Epidemiology, CHU NancyVandoeuvre-lès-NancyFrance

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