Bland Daniel C, Pennock Andrew T, Upasani Vidyadhar V, Edmonds Eric W
Pediatric Orthopedics and Scoliosis Center, Rady Children's Hospital.
Department of Orthopedic Surgery, University of California, San Diego, CA.
J Pediatr Orthop. 2018 Sep;38(8):e429-e433. doi: 10.1097/BPO.0000000000001200.
Lateral condyle fractures of the distal humerus are the second most common pediatric elbow fracture. A difference of 1 or 2 mm in fracture displacement measurement may change the operative or nonoperative management of a minimally displaced fracture. The goal of this study was to determine the interobserver and intraobserver agreement in the measurements of displacement of lateral condyle fractures of the humerus.
A retrospective radiographic review of 60 patients was performed by 3 reviewers. Fracture displacement was measured in millimeters on all radiographic projections and repeated by a single author 1 month later. Intraclass correlation coefficients (ICC) were calculated for intraobserver and interobserver agreement. We then calculated the percentage of measurements that differed by >1 or 2 mm. Analysis was performed on the entire cohort of displaced fractures and again separately for a cohort of minimally displaced fractures (defined as <5 mm).
The combined ICC for intraobserver reliability across all radiographic projections was 0.96 (range, 0.952 to 0.977), but there was disagreement between a single reviewer's own measurements 17.3% of the time. Within the cohort of fractures displaced <5 mL, this intrarater disagreement (>2 mm) dropped to 4%. Interobserver reliability was also high with an ICC of 0.90 (range, 0.861 to 0.924). Within the minimally displaced cohort (<5 mm), the interrater disagreement was 6.6% when using a 2 mm cutoff and 22.2% when using a 1 mm cutoff.
Intraobserver and interobserver reliability are high when measuring lateral condyle fractures and the percent of clinical disagreement is low when measuring minimally displaced fractures for which treatment depends on measuring to the millimeter. The internal oblique projection is the most reliable view for measuring lateral condyle fracture displacement, whereas the external oblique view offers little in terms of reliability. This study may be used as a platform for further research, verifying that reliable measurements of lateral humeral condyle fracture displacement can be obtained within 1 to 2 mm from adequate plain films.
Level III.
肱骨远端外侧髁骨折是儿童肘部第二常见的骨折。骨折移位测量中1或2毫米的差异可能会改变轻度移位骨折的手术或非手术治疗方案。本研究的目的是确定肱骨外侧髁骨折移位测量中的观察者间和观察者内一致性。
3名研究者对60例患者进行了回顾性影像学检查。在所有影像学投照上以毫米为单位测量骨折移位，并由同一作者在1个月后重复测量。计算观察者内和观察者间一致性的组内相关系数（ICC）。然后我们计算了相差>1或2毫米的测量值的百分比。对所有移位骨折队列进行分析，并再次对轻度移位骨折队列（定义为<5毫米）进行单独分析。
所有影像学投照上观察者内可靠性的综合ICC为0.96（范围为0.952至0.977），但单个研究者自身测量值之间有17.3%的时间存在不一致。在移位<5毫升的骨折队列中，这种同一观察者内的不一致（>2毫米）降至4%。观察者间可靠性也很高，ICC为0.90（范围为0.861至0.924）。在轻度移位队列（<5毫米）中，使用2毫米截断值时观察者间不一致为6.6%，使用1毫米截断值时为22.2%。
测量外侧髁骨折时观察者内和观察者间可靠性较高，对于治疗取决于毫米级测量的轻度移位骨折，临床不一致的百分比很低。内斜位投照是测量外侧髁骨折移位最可靠的视图，而外斜位视图在可靠性方面作用不大。本研究可作为进一步研究的平台，验证从适当的平片可获得肱骨外侧髁骨折移位的可靠测量值，误差在1至2毫米内。
三级。
