Purpose Unstable posterior fracture-dislocation of the hip is determined by the wall defect or acetabular fracture index. The unstable hip is a result of inadequate posterior acetabular coverage of the femoral head from the posterior acetabular wall fracture. In order to measure total posterior acetabular coverage of the femoral head and avoid using the contralateral acetabulum as a calculation reference, the posterior acetabular arc angle of the femoral head was measured to assess stability of posterior fracture-dislocation of the hip. Methods Using coronal computed tomography (CT) scan of the normal contralateral acetabulum at the level of the widest acetabular diameter and thinnest medial wall of 60 acetabular fractures, posterior acetabular arc angles of the femoral head in intact, 20 % and 50 % defects of posterior acetabular walls were measured. The angles were measured from the acetabular centre to the thinnest medial wall and to the top, inner cortex of 80 % and 50 % posterior acetabular walls. Results Average intact, 80 % and 50 % posterior acetabular walls were 33.82±4.30, 26.88±3.33 and 16.91±2.15 mm which corresponded to 92.25 ± 11.34, 77.42 ± 10.04 and 50.63±6.58°of posterior acetabular arc angles of the femoral head. The intraclass correlation coefficient (ICC) of the measurements including correlation of conversion of posterior acetabular wall depths to posterior acetabular arc angles of the femoral head were more than 0.82 and 0.89. ConclusionsThe measurement technique of posterior acetabular arc angle of the femoral head has strong reliability. Therefore, stable or unstable posterior fracture-dislocation of the hip can be determined in terms of more than 77 degrees or less than 50 degrees of posterior acetabular arc angles of the femoral head instead of less than 20 % or more than 50 % posterior acetabular wall defect.
Background: Several radiographic measurements of the humerus can be used to evaluate the treatment outcome of supracondylar fractures in children. Because of the cartilaginous nature of the immature elbow, interpretation of radiographs around this area is sometimes challenging and can be unreliable. This study was conducted to determine the inter-observer and intra-observer reliability of the six commonly used radiographic measurements of the distal humerus. Method: The Baumann angle, humero-ulna angle, metaphyseal-diaphyseal angle, radial epiphyseal angle, shaft-condylar angle and lateral capitellohumeral angle of the humerus were measured by two observers on the radiographs of uninjured elbows from 58 children. The values between each measurement were compared and correlated using a Pearson coefficient of correlation to determine the inter-observer and intra-observer reliability. Results: All of the radiographic parameters showed excellent intra-observer reliability with the correlation coefficient values of the Baumann angle, humero-ulna angle, metaphyseal-diaphyseal angle, radial epiphyseal angle, shaft-condylar angle, lateral capitellohumeral angle as 0.945, 0.95, 0.909, 0.888, 0.961 and 0.975 (p < 0.001), respectively. The inter-observer reliability of the Baumann and humero-ulna angles were also found to be highly correlated at r ¼ 0.843 (p < 0.001) and 0.878 (p < 0.001), respectively. The metaphyseal-diaphyseal angle had poor reliability with r ¼ 0.136 (p ¼ 0.291) while the radial epiphyseal angle, shaft-condylar angle, and lateral capitellohumeral angle demonstrated good reliability with r ¼ 0.675 (p < 0.001), 0.747 (p < 0.001), and 0.686 (p < 0.001), respectively. Conclusion: The Baumann angle and humero-ulna angle measurements of distal humerus showed excellent inter-and intra-observer reliability. Both parameters represent repeatable and reliable methods for determining the outcome of supracondylar humeral fractures in pediatric population.
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