Publications (2)2.53 Total impact
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ABSTRACT: Proximal humeral fractures can restrict daily activities and, therefore, deserve efficient diagnoses that minimize complications and sequels. For good diagnosis and treatment, patient characteristics, variability in the forms of the fractures presented, and the technical difficulties in achieving fair results with surgical treatment should all be taken into account. Current classification systems for these fractures are based on anatomical and pathological principles, and not on systematic image reading. These fractures can appear in many different forms, with many characteristics that must be identified. However, many current classification systems lack good reliability, both inter-observer and intra-observer for different image types. A new approach to image reading, following a well-designed set and sequence of variables to check, is needed. We previously reported such an image reading system. In the present study, we report a classification system based on this image reading system. Here we define 21 fracture characteristics and apply them along with classical Codman approaches to classify fractures. We base this novel classification system for classifying proximal humeral fractures on a review of scientific literature and improvements to our image reading protocol. Patient status, fracture characteristics and surgeon circumstances have been important issues in developing this system.Clinical Medicine & Research 07/2009; 7(1-2):32-44.
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ABSTRACT: Fractures of the proximal humerus can be treated effectively but require proper characterization. None of the existing classifications intended to facilitate characterization have been satisfactory. We studied proximal humerus fractures using radiographs alone and radiographs plus computed tomography scans to ascertain which imaging studies were most useful to characterize these fractures. We designed an assessment protocol consisting of 17 parameters divided in four groups: cephalodiaphyseal relationship (six parameters), cephalotuberosity relationship (six parameters), humeral head (two parameters), and fracture fragment description (three parameters). The computed tomography scans were assessed using 11 parameters (the same parameters used for assessing radiographs except for the six cephalodiaphyseal parameters). Four observers analyzed the parameters in 30 selected fractures with biplanar radiographic projections (30 patients) and computed tomography scans (22 patients) on two occasions. We found good interobserver reliability and intraobserver reliability with radiographs alone for the cephalodiaphyseal parameters. The best interobserver reliabilities with radiographs plus computed tomography scans were with the number of fragments, displacement of the lesser tuberosity, and extraarticular or articular fractures. Computed tomography allows better assessment of some parameters in characterizing proximal humeral fractures. The use of a structured protocol in reading images seems useful and allows better reliability than reported for other approaches. LEVEL OF EVIDENCE: Diagnostic study, Level III (study of nonconsecutive patients without consistently applied reference "gold" standard). See the Guidelines for Authors for a complete description of levels of evidence.Clinical Orthopaedics and Related Research 08/2006; 448:225-33. · 2.53 Impact Factor