Preliminary view on new roentgenologic trochleocapitellar index for assessment accuracy of the reduction supracondylar fracture of the elbow in children to comparison Baumann's angle

Abstract

BackgroundsAngulations deformity (cubitus varus and valgus) is the most common complication of displaced supracondylar fractures. Most deformity seems to be related to coronal plane angulations [1]. It should also be appreciated that rotation of the distal fragment often worsens varus and valgus angulations [2]. The deformity results from two factors: primary mal-reduction of the fracture and the limited remodelling in the coronal plane [3]. Prevention of angulations depends on the accurate reduction of the fracture. The gold standard in clinical practice, today, is an assessment of reduction quality using Baumann's angle. Baumann's angle formed by the intersection of a line drawn down the humeral axis and a line drawn along the growth plate of the capitellum of the elbow [4]. This angle correlates closely with the carrying angle [5]. The mean Baumann's angle is 72°±4°. The new TCI of the elbow is the ratio between the smaller trochlear and larger capitellar angles of the measured elbow (Figure 1). The rationale is that an index based on the AbstractBackground: In children supracondylar fracture of the humorous is one of the most common fractures in the first decade of life. This study was conducted to establish the efficacy and the accuracy of a new own method for measuring the Trochleocapitellar index (TCI) in the management of supracondylar humeral fracture in children versus Baumann's angle. Methods: This study made on base AP elbow radiograms and clinical charts of 54 children that were treated due to supracondylar fracture of the elbow. Cases included were of either gender with age range from four to 13 years with a supracondylar fracture presenting within 72 hours of the reduction. Outcome measures: Two measure roentgen logic modalities studied for comparison: Baumann's angle and TCI were taken into consideration when examining the AP roentgenograms (immediately after the reduction and during 1-3 months thereafter). Results: During 1-3 months after the reduction Baumann's angle modality gave normal results in 51 (94.4%), valgus result in one (1.9%) and varus result in two (3.7%) patients. While TCI showed normal results in 31 (57.4%), valgus result in one (1.9%) and varus results in 22 (40.7%) patients. Correlation was found between the measurements of the normal Baumann's angle and normal TCI immediately after fracture reduction (r=0.75, p<0.001) and on the period between one to three months follow-up (r=0.54, p<0.001). TCI was found as more accurate for detection of cubitus varus. Conclusions: Authors recommends post reduction measurement of the TCI in supracondylar fractures to determine the adequacy of reduction.