Iwema, S. (Sijbrand) (2012) Fractuurtype classificatie als voorspeller van radiologische uitkomst bij proximale humerus fracturen. thesis, Medicine.
Full text available on request.Abstract
Background: Shoulder fractures are a very common fracture among the elderly. In recent years, a climb in incidence has occurred and a further increase is expected. Of all patients with a shoulder fracture 70% is 60 years or older and 75% are women. A conservative treatment can be used for proper recovery of function. A more active population of elderly demands more of their arm. The goal of this study is to understand the predictive value of fracture classification systems with respect to the radiological outcome of conservative treatment of shoulder fractures. In addition, a comprehensive overview is given of the occurrence of shoulder fractures classified according to the classification systems. And an overview of the observer reliability of these systems is given. Methods: For this retrospective study, the radiographs of 1254 patients with a shoulder fracture were used. These patients were selected from a database of 1825 patients who were treated in the UMCG between 1991 and 2010 for a shoulder fracture. All radiographs were reviewed by an inexperienced observer (student) and an experienced observer (supervisor). We looked at the first recording and last recording made for shoulder fracture. In assessing the first recording we looked at the classification according to Neer, Hertel and AO. Also the initial angle of the fracture was measured. On the last recording the angle was measured again and we listed if consolidation, necrosis, lysis or displacement had occurred. Results: The reliability of the classifications showed a weak agreement between the experienced and the inexperienced observers. The inexperienced observer had a moderate agreement with the classification according to Hertel while the classifications according to Neer and AO only showed a weak agreement. The experienced observer had good agreement for the classification according to Neer while the classifications according to AO and Hertel showed moderate agreement. Of all patients 34% had fractures along the transition between the shaft and head (surgical neck). In 37% of patients there was no displacement of their fracture. The classification according to Hertel shows that 8% of all patients with a fracture had a four fragment fracture. According to AO 24% had a fracture of a tubercle, 36% had a fracture through the surgical neck and 31% had a combination thereof. . In avascular necrosis only the magnitude of the change of the angle appeared significantly. For lysis, age, comorbidity and length of follow up showed a significant relationship. For consolidation, only the length of follow up had a significant predictive value. In secondary displacement and osteoarthritis age has a significant predictive value. Conclusion: There was only weak agreement between the inexperienced and the experienced observers. The intra-observer reliability of the classification according to Hertel showed a moderate agreement. The experienced observer had a good agreement with the use of the classification according to Neer. For the prediction of avascular necrosis, the magnitude of the change of the angle can be used. For the prediction of lysis age and the presence of co-morbidity can be used. Age can be used for predicting secondary displacement of the fracture and osteoarthritis.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultaire begeleider: and Diercks, Prof. dr. R.L. |
| Supervisor name: | Diercks, Prof. dr. R.L. and Verbeek, drs. P. and Reininga, dr. I.H.F. and Disciplinegroep: Orthopedie, UMCG |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/616 |
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