Intra- and inter-observer agreement in the AO and Garnavos systems for diaphyseal humerus fracture

Abstract

Objective: The objective of this study was to compare inter- and intra-observer agreement using the Garnavos and AO/ASIF systems for classifying humeral diaphysis fractures. Methods: Eighty X-ray images taken of humeral diaphysis fractures in adult patients (age ≥ 18 years) between January 2013 and September 2015 in the Radiology Department of Hospital São Paulo were selected for subsequent classification by five orthopedic surgeons with differing levels of experience. The images were examined at two different times and reproducibility analysis was evaluated using Fleiss' kappa to verify intra- and inter-observer agreement. Results: High-level agreement was observed for both classification systems, but particularly for the AO/ASIF classification. Inter-observer evaluation yielded excellent levels of agreement for both classifications, but principally for the Garnavos classification. Conclusions: Good or excellent interand intra-observer agreement was seen for both the AO/ASIF and Garnavos classification systems. However, intra-observer agreement was higher for the AO/ASIF system and inter-observer agreement was higher for the Garnavos classification. Level of Evidence II, Diagnostic Studies - Investigating a Diagnostic Examination.