The Application Of30-tilt Anteroposterior(A-P)radiography In Assessment Of Displaced Supracondylar Humerus Fractures In Children

Objective：Treatment of choice of displaced supracondylar fracture ofhumerus is closed reduction(reduction, splinting and traction) and surgicaltreatment (open reduction and Kirschner wire fixation or close reduction andpercutaneous pinning techniques). Most scholars believe that timely andeffective reduction and fixation can reduce the incidence of complications,while reducing the risk of incision surgery. Due to the limitations of medicalconditions, a simple manual reduction of emergency orthopedic surgeonsoften becomes the preferred treatment. So the accuracy of the operation,reliability and success rate are very important. Forearm rotation is one of themost common complications of manual reduction, which if you do not fullyrecognized or improper handling can cause serious complications such ascubitus valgus deformity or chronic ulnar neuritis. In this study we are tryingto investigate the accuracy and values of30°―tilt anteroposterior(A_P)radiography in assessment of the direction of forearm rotation after the manualreduction treatment of supracondylar fracture of humerus in childrencompared to the conventional lateral radiography, and provide guidance forthe clinical treatment.Methods: In this study, from the February2012to the February2014,weselected46children between the ages of2to12,which with the forearmrotation judged by lateral radiography after the manual reduction treatment ofsupracondylar fracture of humerus, treated in trauma care center of The ThirdAffiliated Hospital of Hebei Medical University. After finding out theevidence of forearm rotation on the lateral x-ray films,30°―tiltanteroposterior radiography and CT three-dimensional imaging of limb elbowthen should been taken. By radiological features, clinical data for further analysis were used to determine the direction of rotation of the forearm. WithCT as the gold standard of diagnosis, calculated the accuracy of the results ofthe two groups，and then by retrospective study to analyze whether there arestatistically significant differences in accuracy of the two methods. Using thechi-square test of exact Fisher, P <0.05was significantly different criteria tostatistical analysis of the results. All figures are calculated through statisticalsoftware (SPSS-16.0).Results:1In lateral, oblique and CT groups, no case has been ruled out. In all46subjects, a total of36people occurred external rotation, of which five peoplelateral column shifted post,29people inside column moved forward, onepeople occurred double-column rotation; total of nine person occurred internalrotation, which has a forward lateral column of one person, a post insidecolumn of seven person, double-column rotation of three people. Table Ishows the results of a detailed examination of postoperative CT.2Observers got their correct results and erroneous results through lateralradiography and oblique radiography.The results and relationship shown inTable II. Correct results viewer got through lateral film-reading is31, error15,the accuracy was67.39%. Correct results obtained by being oblique for39,7errors, the accuracy was84.78%. The results of the two groups are bothcorrect as29, both error as5.3When comparing the lateral radiography group and oblique radiographygroup to determine whether the two methods exists differences, using Fisher’sexact test P value was0.029. Statistical data shows that there are significantdifferences in diagnostic accuracy between the lateral radiography and obliqueradiography.(P <0.05).Conclusion: Internal rotation and external rotation both may occur aftermanual reduction treatment of supracondylar fractures.30-tilt anteroposteriorradiography, compared with conventional radiographs of the elbow, can bemore effective, more accurate to determine the distal direction of rotation afterthe manual reduction treatment of supracondylar fracture of humerus. Although the exact rate of the two methods are both inferior CT diagnostics,but in the condition without CT, oblique X-ray examination can be used as analternative test method, and can improve the accuracy of diagnosis to a certainextent. Thus, it can serve as an important basis for being used to determine theaccuracy and value of manual reduction treatment, and can effectively preventor correct the problem of forearm rotation (mainly the corrected rotation)aftermanual reduction, as well as can reduce the incidence of cubitus varusdeformity.