The radiographs of ninety-five fractures of the proximal end of the
humerus were classified with the Neer and the AO/ASIF systems by five
orthopaedic surgeons who had a special interest in problems of the
shoulder. Without access to their initial interpretations, the same five
orthopaedic surgeons reevaluated the same radiographs eight weeks later.
Intraobserver and intraobserver reliability were found to be fair or poor
for both classification systems. Kappa values for the interobserver
reliability were 0.40 for the Neer system and 0.53 for the AO/ASIF system.
When the fractures were subclassified, according to the recommendations of
the AO/ASIF, into groups and subgroups, reproducibility became
progressively worse. Intraobserver reliability showed kappa values of 0.60
and 0.58, respectively. A so-called extended radiographic trauma series,
consisting of three perpendicular radiographs, was available for
thirty-five fractures; the third perpendicular projection did not
significantly improve the reproducibility values for either classification
compared with those obtained with only two perpendicular projections. We
concluded that neither the Neer nor the AO/ASIF classification of fractures
of the proximal end of the humerus is sufficiently reproducible to allow
meaningful comparison of similarly classified fractures in different
studies.