Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 28;12(9):3168.
doi: 10.3390/jcm12093168.

Inter-Observer and Intra-Observer Reliability Assessment of the Established Classification Systems for Periprosthetic Shoulder Fractures

Mats Wiethölter  1   2 , Doruk Akgün  2 , Fabian Plachel  2 , Marvin Minkus  2 , Daniel Karczewski  2 , Karl Braun  3 , Kathi Thiele  2 , Luis Becker  2 , Ulrich Stöckle  2 , Philipp Moroder  4
Affiliations

Inter-Observer and Intra-Observer Reliability Assessment of the Established Classification Systems for Periprosthetic Shoulder Fractures

Mats Wiethölter et al. J Clin Med. .

Abstract

This study evaluated the reliability and comprehensiveness of the Unified classification system (UCPF), Wright & Cofield, Worland and Kirchhoff classifications and related treatment recommendations for periprosthetic shoulder fractures (PPSFx). Two shoulder arthroplasty specialists (experts) and two orthopaedic residents (non-experts) assessed 20 humeral-sided and five scapula-sided cases of PPSFx. We used the unweighted Cohen's Kappa (κ) for measuring the intra-observer reliability and Krippendorff's alpha (α) for measuring the inter-observer reliability. The inter-rater reliabilities for the Wright & Cofield and Worland classifications were substantial for all groups. The expert and non-expert groups for UCPF also showed substantial inter-rater agreement. The all-rater group for the UCPF and the expert and non-expert group for the Kirchhoff classification revealed moderate inter-rater reliability. For the Kirchhoff classification, only fair inter-rater reliability was found for the non-expert group. Almost perfect intra-rater reliability was measured for all groups of the Wright & Cofield classification and the all-rater and expert groups of the UCPF. All groups of the Kirchhoff and Worland classifications and the group of non-experts for the UCPF had substantial intra-rater reliabilities. Regarding treatment recommendations, substantial inter-rater and moderate intra-rater reliabilities were found. Simple classification systems for PPSFx (Wright & Cofield, Worland) show the highest inter- and intra-observer reliability but lack comprehensiveness as they fail to describe scapula-sided fractures. The complex Kirchhoff classification shows limited reliability. The UCPF seems to offer an acceptable combination of comprehensiveness and reliability.

Keywords: classification; periprosthetic shoulder fractures; reliability; shoulder arthroplasty; treatment recommendation.

PubMed Disclaimer

Conflict of interest statement

P.M. has received consulting fees from Arthrex Inc., Medacta, and Alyve Medical. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Classification of Wright & Cofield [12]. Purple lines show fracture extensions. (a) Type-A-fracture: around the tip of the prosthesis stem with extension proximally by more than one-third of the length of the prosthesis stem. (b) Type-B-fracture: localized at the tip of the prosthesis with distal extension. (c) Type-C-fractures: localized distal to the tip of the prosthesis stem.
Figure 2
Figure 2
Classifications of Worland et al. [11]. Purple lines show fracture extensions. (a) Type-A-fracture: includes fractures of the tubercula; (b–d) Type-B-fractures: fractures in the shaft region. (b) Type-B1-fracture: a spiral shaft fracture with a stable shaft. (c) Type-B2-fracture: a transverse fracture with a stable shaft. (d) Type-B3-fracture: in the shaft area with a loosened prosthesis shaft. (e) Type-C-fracture: located sufficiently far distal to the prosthesis shaft.
Figure 3
Figure 3
Kirchhoff classification for periprosthetic shoulder fractures [19].
See this image and copyright information in PMC

References

    1. Lübbeke A., Rees J.L., Barea C., Combescure C., Carr A.J., Silman A.J. International variation in shoulder arthroplasty. Acta Orthop. 2017;88:592–599. doi: 10.1080/17453674.2017.1368884. - DOI - PMC - PubMed
    1. Wagner E.R., Farley K.X., Higgins I., Wilson J.M., Daly C.A., Gottschalk M.B. The incidence of shoulder arthroplasty: Rise and future projections compared with hip and knee arthroplasty. J. Shoulder Elb. Surg. 2020;29:2601–2609. doi: 10.1016/j.jse.2020.03.049. - DOI - PubMed
    1. Brusalis C.M., Taylor S.A. Periprosthetic Fractures in Reverse Total Shoulder Arthroplasty: Current Concepts and Advances in Management. Curr. Rev. Musculoskelet. Med. 2020;13:509–519. doi: 10.1007/s12178-020-09654-8. - DOI - PMC - PubMed
    1. Williams G.R., Iannotti J.P. Management of periprosthetic fractures: The shoulder. J. Arthroplast. 2002;17:14–16. doi: 10.1054/arth.2002.32683. - DOI - PubMed
    1. Steinmann S.P., Cheung E.V. Treatment of Periprosthetic Humerus Fractures Associated with Shoulder Arthroplasty. J. Am. Acad. Orthop. Surg. 2008;16:199–207. doi: 10.5435/00124635-200804000-00003. - DOI - PubMed

LinkOut - more resources