Şahbat Yavuz, Bekiroğlu Gülnaz Nural, Çat Görkem, Gündoğdu Mert, Ağirdil Yücel, Çayir Hüseyin, Onay Tolga, Akgülle Ahmet Hamdi
Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey.
Department of Biostatistics, Marmara University School of Medicine, Istanbul, Turkey.
J Pediatr Orthop. 2023;43(10):603-607. doi: 10.1097/BPO.0000000000002512. Epub 2023 Sep 9.
Rotational malalignment is a common problem in pediatric supracondylar humerus fractures (SCHF). Several techniques have been described to evaluate the true rotation value. Although the Prabhakar and Gordon techniques are used frequently, their superiority to each other in terms of measurement quality is unknown.
QUESTIONS/PURPOSES: The aim of this study was to investigate the clinical compatibility of the 2 techniques and to evaluate whether they are suitable for all subtypes.
This cross-sectional study included 40 patients with SCHF (including subtypes; Typical, Medial Oblique, Lateral Oblique, and High fracture pattern). The Gordon lateral rotation percentage and Prabhakar percentage of metaphyseal overhang were measured twice by 4 experienced Orthopedics and Traumatology surgeons at 8-week intervals. The interobserver and intraobserver reliability were examined using the intraclass correlation coefficient.
The interobserver reliability for Gordon and Prabhakar technique was 0.816 and 0.762 for the first measurement and 0.811 and 0.811 for the second measurement, respectively.The medial oblique fracture pattern was determined to have the best interobserver agreement among the subtypes. The result was excellent for the medial and lateral oblique subtypes, good for the typical fracture pattern, and fair for the high fracture pattern. The intraobserver reliability for Gordon and Prabhakar technique was excellent, 0.924 and 0.922, respectively.
The main finding of this study was that the Gordon and Prabhakar techniques have similar interobserver and intraobserver reliability. Although the Gordon technique tends to have higher interobserver reliability, the difference was clinically insignificant. These measurements should not be relied upon in cases of SCHF with a high fracture pattern because of the different anatomic features of that region.
Level III.
旋转畸形是小儿肱骨髁上骨折（SCHF）中的常见问题。已经描述了几种评估真实旋转值的技术。尽管普拉巴卡尔（Prabhakar）技术和戈登（Gordon）技术经常被使用，但它们在测量质量方面的相互优越性尚不清楚。
问题/目的：本研究的目的是调查这两种技术的临床兼容性，并评估它们是否适用于所有亚型。
这项横断面研究纳入了40例SCHF患者（包括典型、内侧斜形、外侧斜形和高位骨折类型）。4名经验丰富的骨科和创伤外科医生每隔8周对戈登外侧旋转百分比和普拉巴卡尔干骺端悬垂百分比进行两次测量。使用组内相关系数检查观察者间和观察者内的可靠性。
戈登技术和普拉巴卡尔技术的观察者间可靠性，第一次测量分别为0.816和0.762，第二次测量分别为0.811和0.811。在内侧斜形骨折类型中，观察者间一致性最佳。内侧和外侧斜形亚型的结果为优，典型骨折类型为良，高位骨折类型为中。戈登技术和普拉巴卡尔技术的观察者内可靠性均为优，分别为0.924和0.922。
本研究的主要发现是，戈登技术和普拉巴卡尔技术在观察者间和观察者内可靠性方面相似。尽管戈登技术的观察者间可靠性往往更高，但差异在临床上无显著意义。由于该区域不同的解剖特征，在高位骨折类型的SCHF病例中不应依赖这些测量方法。
III级。
