[Predictive Factors and Treatment of Aseptic Pseudoarthrosis of the Humeral Shaft].

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Abstract

[Indexed for MEDLINE] 4. J Clin Orthop Trauma. 2025 Dec 8;72:103302. doi: 10.1016/j.jcot.2025.103302. eCollection 2026 Jan. Multicenter reliability study of the universal long bone nonunion classification. Semenistyy AA(1), Solomin LN(2), Komarov AV(3), Mitsikov RY(4), Tasev BG(5), Mironov AN(6). Author information: (1)Department of Orthopedics and Traumatology, Faculty of Medicine, Medical University of Sofia, Blvd. Akad Ivan Geshov 15, Sofia, 1431, Bulgaria. (2)Department of Orthopedic Surgery, Vreden National Research Orthopedic Centre, Akad. Baykov str. 8, Saint Petersburg, 195427, Russian Federation. (3)Department of Military Traumatology and Orthopedics, S. M. Kirov Military Medical Academy, Akad. Lebedev str. G, Saint Petersburg, 194044, Russian Federation. (4)Department of Traumatology and Orthopedics, Rostov State Medical University, Suvorov str. 119, Rostov-on-Don, 344022, Russian Federation. (5)Department of Traumatology, "N.I. Pirogov" University Emergency Hospital, Blvd. Gen. Totleben 21, Sofia, 1606, Bulgaria. (6)Department of Traumatology and Orthopedics, Moscow, "Acad. G.M. Savelieva" City Clinical Hospital, Lobachevskogo str.42/1, Moscow, 119415, Russian Federation. BACKGROUND: A universal classification providing a clinically relevant and anatomically comprehensive framework for long bone nonunions has been recently introduced. This study aimed to evaluate its inter- and intra-observer reliability and compare its performance with the widely used Weber-Cech classification. METHODS: This multicenter, three-stage validation study included 191 cases meeting the FDA definition of nonunion. Four expert raters participated. In Stage 1, cases were classified using existing systems: AO/OTA for anatomical location and Weber-Cech for biological type. In Stage 2, 133 eligible cases were independently classified using the Universal Long Bone Nonunion Classification (ULBNC) in two rounds, two weeks apart. Stage 3 involved refinement of classification criteria based on feedback and statistical analysis, followed by re-assessment of 90 cases. Inter-observer reliability was assessed using free-marginal Fleiss' kappa; intra-observer reliability using Cohen's kappa with linear weighting. RESULTS: Substantial to almost perfect inter-observer agreement was observed for type classification (κ = 0.85), with the highest reliability in diaphyseal nonunions (κ = 0.90). Incorporating pathological mobility significantly improved agreement compared to Weber-Cech (κ = 0.38, p