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Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: a prospective study.

Bahrs C, Schmal H, Lingenfelter E, Rolauffs B, Weise K, Dietz K, Helwig P - BMC Musculoskelet Disord (2008)

Bottom Line: A precise modular topographic-morphological (MTM) classification for proximal humeral fractures may address current classification problems.An acceptable reliability was found for the simple version classifying fracture displacement and fractured main parts.Fair interobserver agreement was found for the extensive version with individual topographic fracture type and morphology.

View Article: PubMed Central - HTML - PubMed

Affiliation: BG Trauma Center, Eberhard-Karls-University, Schnarrenbergstr, 95, D-72076 Tuebingen, Germany. C.Bahrs@gmx.de

ABSTRACT

Background: A precise modular topographic-morphological (MTM) classification for proximal humeral fractures may address current classification problems. The classification was developed to evaluate whether a very detailed classification exceeding the analysis of fractured parts may be a valuable tool.

Methods: Three observers classified plain radiographs of 22 fractures using both a simple version (fracture displacement, number of parts) and an extensive version (individual topographic fracture type and morphology) of the MTM classification. Kappa-statistics were used to determine reliability.

Results: An acceptable reliability was found for the simple version classifying fracture displacement and fractured main parts. Fair interobserver agreement was found for the extensive version with individual topographic fracture type and morphology.

Conclusion: Although the MTM-classification covers a wide spectrum of fracture types, our results indicate that the precise topographic and morphological description is not delivering reproducible results. Therefore, simplicity in fracture classification may be more useful than extensive approaches, which are not adequately reliable to address current classification problems.

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The further division of type B fractures (Three-part B-fractures) depends on the additionally occurring tuberosity fractures. a) GBL fractures = incomplete fracture of the anatomical neck with extension into the greater tuberosity (GB) with a fracture of the lesser tuberosity. b) LBG fractures = incomplete fracture of the anatomical neck with extension into the lesser tuberosity (LB) with a fracture of the greater tuberosity. c) MBG fractures = incomplete articular fractures with an medial metaphyseal fragment at the humeral head (MB) with a fracture of the greater tuberosity. d) MBL fractures = incomplete articular fractures with an medial metaphyseal fragment at the humeral head (MB) with a fracture of the lesser tuberosity. e) MBT fractures = 4-Part B fractures appear which are MB fractures in combination with a fracture of both tuberosities (G and L = T) = MBT fractures.
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Figure 4: The further division of type B fractures (Three-part B-fractures) depends on the additionally occurring tuberosity fractures. a) GBL fractures = incomplete fracture of the anatomical neck with extension into the greater tuberosity (GB) with a fracture of the lesser tuberosity. b) LBG fractures = incomplete fracture of the anatomical neck with extension into the lesser tuberosity (LB) with a fracture of the greater tuberosity. c) MBG fractures = incomplete articular fractures with an medial metaphyseal fragment at the humeral head (MB) with a fracture of the greater tuberosity. d) MBL fractures = incomplete articular fractures with an medial metaphyseal fragment at the humeral head (MB) with a fracture of the lesser tuberosity. e) MBT fractures = 4-Part B fractures appear which are MB fractures in combination with a fracture of both tuberosities (G and L = T) = MBT fractures.

Mentions: B fractures with four main parts (= 4-part B fractures) are MB fractures in combination with a fracture of both tuberosities (MBT) (see Figure 3 and 4).


Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: a prospective study.

Bahrs C, Schmal H, Lingenfelter E, Rolauffs B, Weise K, Dietz K, Helwig P - BMC Musculoskelet Disord (2008)

The further division of type B fractures (Three-part B-fractures) depends on the additionally occurring tuberosity fractures. a) GBL fractures = incomplete fracture of the anatomical neck with extension into the greater tuberosity (GB) with a fracture of the lesser tuberosity. b) LBG fractures = incomplete fracture of the anatomical neck with extension into the lesser tuberosity (LB) with a fracture of the greater tuberosity. c) MBG fractures = incomplete articular fractures with an medial metaphyseal fragment at the humeral head (MB) with a fracture of the greater tuberosity. d) MBL fractures = incomplete articular fractures with an medial metaphyseal fragment at the humeral head (MB) with a fracture of the lesser tuberosity. e) MBT fractures = 4-Part B fractures appear which are MB fractures in combination with a fracture of both tuberosities (G and L = T) = MBT fractures.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2275241&req=5

Figure 4: The further division of type B fractures (Three-part B-fractures) depends on the additionally occurring tuberosity fractures. a) GBL fractures = incomplete fracture of the anatomical neck with extension into the greater tuberosity (GB) with a fracture of the lesser tuberosity. b) LBG fractures = incomplete fracture of the anatomical neck with extension into the lesser tuberosity (LB) with a fracture of the greater tuberosity. c) MBG fractures = incomplete articular fractures with an medial metaphyseal fragment at the humeral head (MB) with a fracture of the greater tuberosity. d) MBL fractures = incomplete articular fractures with an medial metaphyseal fragment at the humeral head (MB) with a fracture of the lesser tuberosity. e) MBT fractures = 4-Part B fractures appear which are MB fractures in combination with a fracture of both tuberosities (G and L = T) = MBT fractures.
Mentions: B fractures with four main parts (= 4-part B fractures) are MB fractures in combination with a fracture of both tuberosities (MBT) (see Figure 3 and 4).

Bottom Line: A precise modular topographic-morphological (MTM) classification for proximal humeral fractures may address current classification problems.An acceptable reliability was found for the simple version classifying fracture displacement and fractured main parts.Fair interobserver agreement was found for the extensive version with individual topographic fracture type and morphology.

View Article: PubMed Central - HTML - PubMed

Affiliation: BG Trauma Center, Eberhard-Karls-University, Schnarrenbergstr, 95, D-72076 Tuebingen, Germany. C.Bahrs@gmx.de

ABSTRACT

Background: A precise modular topographic-morphological (MTM) classification for proximal humeral fractures may address current classification problems. The classification was developed to evaluate whether a very detailed classification exceeding the analysis of fractured parts may be a valuable tool.

Methods: Three observers classified plain radiographs of 22 fractures using both a simple version (fracture displacement, number of parts) and an extensive version (individual topographic fracture type and morphology) of the MTM classification. Kappa-statistics were used to determine reliability.

Results: An acceptable reliability was found for the simple version classifying fracture displacement and fractured main parts. Fair interobserver agreement was found for the extensive version with individual topographic fracture type and morphology.

Conclusion: Although the MTM-classification covers a wide spectrum of fracture types, our results indicate that the precise topographic and morphological description is not delivering reproducible results. Therefore, simplicity in fracture classification may be more useful than extensive approaches, which are not adequately reliable to address current classification problems.

Show MeSH
Related in: MedlinePlus