'Absolute' inter-observer classifications agreement for proximal humeral fractures with a single shoulder anteroposterior X-ray.

PURPOSE: Several studies have been carried out, and there is no classification for proximal humeral fractures (PHF) exempted from variability in interpretation and with questioned reliability. In the present study, we investigated the 'absolute diagnostic reliability' of the most currently used classifications for PHFs on a single anterior-posterior X-ray shoulder image. METHODS: Six orthopaedic surgeons, with varying levels of experience in shoulder pathology, evaluated radiographs from 30 proximal humeral fractures, according to the 'absolute reliability' criteria. Each of the observers rated each fracture according to Neer, Müller/AO and Codman-Hertel's classification systems. RESULTS: The overall inter-observer agreement (κ) has been 0.297 (CI95% 0.280 to 0.314) for the Neer's classification system, 0.206 (CI95% 0.193 to 0.218) for the Müller/AO classification system, and 0.315 (CI95% 0.334 to 0.368) for the Codman-Hertel classification system. We found loss of agreement in Neer's classification as the study progressed, low agreement in the AO classification, and stable values in the different evaluations with the best degree of agreement for Codman-Hertel classification, with a moderate agreement in the second evaluation among the six evaluators. CONCLUSION: The Neer, AO, and Hertel-Codman classification systems for PHF with a single radiographic projection have a difficult interpretation for orthopaedic surgeons of varying levels of experience, and therefore substantial agreements are not obtained.

Fascitis Plantar: Opciones terapéuticas / Plantar Fasciitis: Treatment strategies

La talalgia es la causa más frecuente de consulta a los especialistas en pie y tobillo, entre un 11% y un 15%. En la mayoría de los casos se debe a un proceso de degeneración fibrosa en la inserción fascial de la tuberosidad medial del calcáneo al que llamamos fascitis plantar. Existen multitud de tratamientos que se han mostrado efectivos para la fascitis plantar, desde el uso de plantillas o taloneras hasta la fasciotomia quirúrgica, pasando por las infiltraciones articulares o los suplementos de colágeno en la dieta. Después de analizar la evidencia científica de los diferentes tratamientos utilizados, no se ha encontrado ninguna opción de la que se haya demostrado evidencia fuerte del beneficio en la que basar la práctica clínica, por ello diseñamos un estudio prospectivo en el que establecimos en pacientes que tenían el diagnóstico de fascitis plantar 4 líneas de tratamiento diferentes. El objetivo del presente estudio es conocer los resultados de 4 líneas terapéuticas diferentes en pacientes en los que iniciamos un primer escalón de tratamiento, para conocer si alguna de estas líneas nos aporta beneficios en la eliminación del dolor, la recuperación de la funcionalidad o ambas

Heel pain is the most common cause of medical consultation in foot and ankle specialists, constituting between 11% and 15% of them. In most cases it is due to a process of fibrous degeneration in the fascial insertion of the medial tuberosity of the calcaneus, the plantar fasciitis. Many treatmens have been shown to be effective for plantar fasciitis, starting with the use of orthotics to other more aggressive procedures as surgical fasciotomy passing through other terapies as joint infiltrations or collagen supplements. After a scientific review of the different treatments, no option has demonstrated strong evidence of benefit on which to base clinical practice, thus we designed a prospective study in which we established 4 different lines of treatment in patients who had the diagnosis of plantar fasciitis. Objetive: To analyze the effectiveness of the interventions in the management of plantar fasciitis