The John Hopkins classification system used in pediatric supracondylar humerus fractures requires more experience than the Gartland system.

The Gartland classification is used to decide on surgery. In contrast, the John Hopkins classification system predicts clinical outcomes for patients undergoing surgery and determines the risk of reduction loss. This study aims to investigate the usability of the Gartland and the John Hopkins classification systems by pediatric and general orthopedic surgeons. The preoperative images of 200 patients who presented at a tertiary-level trauma center with a supracondylar humerus fracture were examined by 4 observers, twice at an interval of 6 weeks. The observers comprised 2 pediatric orthopedic surgeons and 2 orthopedics and traumatology surgeons. Inter- and intra-observer reliability were excellent for the first and second measurements of the Gartland classification. The inter-observer agreement of the pediatric orthopedic surgeons and the general orthopedic surgeons was found to be similar (ICC >90). Inter-observer reliability was excellent (ICC: 0.808) and good (ICC: 0.732) for the measurements of the John Hopkins classification, respectively. The inter-observer agreement of the pediatric orthopedic surgeons and the general orthopedic surgeons was not similar. The inter-observer agreement between the two pediatric orthopedic surgeons was excellent for the measurements (ICC: 0.868; ICC: 0.756, respectively). The inter-observer agreement between the two general orthopedic surgeons was good for the measurements (ICC: 0.605; ICC: 0.663, respectively). The John Hopkins classification system has good intra- and inter-observer reliability, and a high experience level increases the agreement. The Gartland classification system was not affected by experience. This should be considered when taking measurements in studies and patient management.

Reliability of Gordon Lateral Rotation Percentage and Prabhakar Percentage of Metaphyseal Overhang for Pediatric Supracondylar Humerus Fracture; Is it Clinically Reliable for John Hopkins Classification Coronal Fracture Subtypes?

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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 OF EVIDENCE: Level III.

An unusual injury pattern: arm wrestling injury, treatment modalities, clinical outcomes, and return to sport.

BACKGROUND: In the sport of arm wrestling, the great rotational force is applied to the upper extremity, which can result in muscle and tendon injuries in the shoulder, elbow, and wrist joints, and even bone fractures. The aim of this study was to present the treatment modalities, functional outcomes, and return to sport after arm wrestling injuries. METHODS: A retrospective evaluation was made of the trauma mechanisms, treatment modalities, clinical outcomes, and time of return to sports of patients admitted to our hospital with an arm wrestling injury between 2008 and 2020. At the final follow-up examination, the functional scores (DASH score and constant score) of the patients were evaluated. RESULTS: Evaluation was made of 22 patients comprising 18 (82%) males and 4 (18%) females with a mean age of 20±6.1 years (range, 12-33 years). Two (10%) patients were professional arm wrestlers. The DASH scores at the final follow-up (mean 4 years) examination were 0.57 (min: 0 and max: 1.7) for the patients with humerus shaft fracture. All the patients with isolated soft-tissue injuries returned to sports within 1 month. Patients with humeral shaft fractures returned to sports later and had a lower functional score (P<0.05). There was no disability in any patient during long-term follow-up. Patients with soft-tissue injuries continued arm wrestling more than patients with bone injuries (P<0.001). CONCLUSION: This study constitutes the largest patient series evaluating patients presenting at a health-care institution with any complaint after arm wrestling. Arm wrestling is not a sport that only results in bone pathologies. Therefore, providing the participants in this sport with information that they may be injured in arm wrestling but there will be a full recovery, may reassure and encourage them.