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

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p

Biomechanical comparison of fixation methods in transverse olecranon fractures: A cadaveric study

Objectives/Hypothesis: Our null hypothesis was that no difference in fracture displacement would be detected between traditional monofilament wire and Kirschner wire placement versus three modified tension-band techniques for transverse olecranon fractures. Study Design: A nested form of the repeated measures design with twenty-two paired embalmed elbows (subjects grouped by sex and nested within the fracture method). Methods: Transverse osteotomies were created at the olecranon and stabilized with four techniques. One hundred cycles of loading were applied to achieve a peak flexion bending moment at the fracture of nine newton-meters. At the onset of testing, the triceps tendon was anchored at an initial elbow flexion angle of 70 degrees. Results: When using a monofilament figure-eight loop, oblique Kirschner wire placement into the anterior ulnar cortex provided greater resistance to tensile force than intramedullary Kirschner wires (p = 0.04). With intramedullary Kirschner wire placement, 1.6-millimeter-diameter braided cable in both figure-eight (p \u3c 0.0001) and circular loop (p \u3c 0.0001) designs allowed less fracture displacement than did the 1.0-millimeter-diameter monofilament wire. There was no difference between figureeight and circular loop configurations when using braided cable (p = 0.98). Conclusions: In transverse noncomminuted olecranon fractures, fixation with monofilament wire is superior with Kirschner wire placement into the anterior ulnar cortex. With intramedullary Kirschner wires, fixation using braided cable is significantly improved over that with monofilament wire. When using braided cable, figure-eight and circular loop designs allow similar displacements. Braided cable or anterior cortical Kirschner wire purchase increases the stability of fixation over that achieved with the traditional method. © 1997 LippincoU-Raven Publishers,

Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: A prospective study-4

Ic neck and fracture of the greater tuberosity. c) CL fracture = complete fracture through the anatomic neck and fracture of the lesser tuberosity. d) CT fracture = complete fracture through the anatomic neck and fracture of both tuberosities (G and L = T). e) CTM fracture = complete fracture through the anatomic neck and fracture of both tuberosities and metaphyseal fracture.<p><b>Copyright information:</b></p><p>Taken from "Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: A prospective study"</p><p>http://www.biomedcentral.com/1471-2474/9/21</p><p>BMC Musculoskeletal Disorders 2008;9():21-21.</p><p>Published online 17 Feb 2008</p><p>PMCID:PMC2275241.</p><p></p

Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: A prospective study-1

E. a2) Vertical M fracture = isolated metaphyseal fracture coming from the anatomic neck proceeding lateral from the lesser tuberosity to distal medial through the metaphysis. b) G fracture = isolated fracture of the greater tuberosity. c) L fracture = islolated fracture of the lesser tuberosity. d) MG fracture = metaphyseal fracture and fracture of the greater tuberosity. e) ML fracture = metaphyseal fracture and fracture of the lesser tuberosity. f) MT fracture = metaphyseal fracture and fracture of both tuberosities.<p><b>Copyright information:</b></p><p>Taken from "Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: A prospective study"</p><p>http://www.biomedcentral.com/1471-2474/9/21</p><p>BMC Musculoskeletal Disorders 2008;9():21-21.</p><p>Published online 17 Feb 2008</p><p>PMCID:PMC2275241.</p><p></p

Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: A prospective study-3

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.<p><b>Copyright information:</b></p><p>Taken from "Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: A prospective study"</p><p>http://www.biomedcentral.com/1471-2474/9/21</p><p>BMC Musculoskeletal Disorders 2008;9():21-21.</p><p>Published online 17 Feb 2008</p><p>PMCID:PMC2275241.</p><p></p

Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: A prospective study-2

Re of the anatomical neck with extension into the lesser tuberosity (LB). c) incomplete articular fractures with an medial metaphyseal wedge shaped fragment at the humeral head (MB).<p><b>Copyright information:</b></p><p>Taken from "Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: A prospective study"</p><p>http://www.biomedcentral.com/1471-2474/9/21</p><p>BMC Musculoskeletal Disorders 2008;9():21-21.</p><p>Published online 17 Feb 2008</p><p>PMCID:PMC2275241.</p><p></p