ABSTRACT
OBJECTIVE: The aim of this study is to estimate the inter- and intra-observer agreement of the Weiss and Milch classification systems in radiological studies of fractures of the lateral humeral condyle in pediatric patients. METHODS: An agreement study was performed with non-probability sampling of consecutive cases with a sample size of a hundred radiological studies, which were evaluated by three experienced orthopedic surgeons and three resident physicians; following a thorough comparison of both inter- and intra-observer agreements over a six-week period based on the Fleiss' kappa, which was used to determine the inter- and intra-observer agreement rates of both classifications. RESULTS: The overall reliability of the entire group of evaluators for the Milch classification in the inter-observer evaluation was κ = 0.13, 95% CI, 0.08-0.18, and the intra-observer evaluation was κ = 0.08, 95% CI, 0.06-0.11. For the Weiss classification, the overall evaluation had an inter-observer agreement of κ = 0.53, 95% CI, 0.50-0.57, and an intra-observer agreement of κ = 0.22, 95% CI, 0.20 -0.24. CONCLUSION: In the present study, the Weiss classification system demonstrated greater agreement than the Milch classification; however, the latter may require complementary studies, such as an arthrography to enhance classification accuracy. Level of Evidence II, Diagnostic Studies - Investigating Diagnostic Examination.
OBJETIVO: Este estudo visa estimar a concordância intra e interobservador da classificação de Weiss e Milch, em estudos radiológicos de pacientes pediátricos com fratura da parte lateral do côndilo do úmero. MÉTODOS: Estudo de concordância realizado com amostragem não probabilística de casos consecutivos com amostra de cem estudos radiológicos que foram avaliados por três observadores especialistas e por três médicos residentes; depois de uma comparação completa da concordância inter e intraobservador durante seis semanas, com base no kappa de Fleiss, que foi usado para determinar a concordância inter e intraobservador das duas classificações. RESULTADOS: A confiabilidade global de todo o grupo de avaliadores da classificação de Milch na avaliação interobservador foi κ = 0,13, IC 95% 0,08-0,18 e intraobservador foi κ = 0,08, IC 95% 0,06-0,11. A avaliação geral da classificação de Weiss obteve concordância interobservador de κ = 0,53, IC 95% 0,50-0,57 e intraobservador de κ = 0,22, IC 95% 0,20-0,24. CONCLUSÃO: No presente estudo, o sistema de classificação de Weiss mostrou concordância maior do que a classificação Milch; contudo, esta última pode exigir estudos complementares, como artrografia, para ampliar a acurácia da classificação. Nível de Evidência II, Estudos Diagnósticos - Investigação de um Exame para Diagnóstico.
ABSTRACT
ABSTRACT Objective: The aim of this study is to estimate the inter- and intra-observer agreement of the Weiss and Milch classification systems in radiological studies of fractures of the lateral humeral condyle in pediatric patients. Methods: An agreement study was performed with non-probability sampling of consecutive cases with a sample size of a hundred radiological studies, which were evaluated by three experienced orthopedic surgeons and three resident physicians; following a thorough comparison of both inter- and intra-observer agreements over a six-week period based on the Fleiss' kappa, which was used to determine the inter- and intra-observer agreement rates of both classifications. Results: The overall reliability of the entire group of evaluators for the Milch classification in the inter-observer evaluation was κ = 0.13, 95% CI, 0.08-0.18, and the intra-observer evaluation was κ = 0.08, 95% CI, 0.06-0.11. For the Weiss classification, the overall evaluation had an inter-observer agreement of κ = 0.53, 95% CI, 0.50-0.57, and an intra-observer agreement of κ = 0.22, 95% CI, 0.20 −0.24. Conclusion: In the present study, the Weiss classification system demonstrated greater agreement than the Milch classification; however, the latter may require complementary studies, such as an arthrography to enhance classification accuracy. Level of Evidence II, Diagnostic Studies - Investigating Diagnostic Examination.
RESUMO Objetivo: Este estudo visa estimar a concordância intra e interobservador da classificação de Weiss e Milch, em estudos radiológicos de pacientes pediátricos com fratura da parte lateral do côndilo do úmero. Métodos: Estudo de concordância realizado com amostragem não probabilística de casos consecutivos com amostra de cem estudos radiológicos que foram avaliados por três observadores especialistas e por três médicos residentes; depois de uma comparação completa da concordância inter e intraobservador durante seis semanas, com base no kappa de Fleiss, que foi usado para determinar a concordância inter e intraobservador das duas classificações. Resultados: A confiabilidade global de todo o grupo de avaliadores da classificação de Milch na avaliação interobservador foi κ = 0,13, IC 95% 0,08-0,18 e intraobservador foi κ = 0,08, IC 95% 0,06-0,11. A avaliação geral da classificação de Weiss obteve concordância interobservador de κ = 0,53, IC 95% 0,50-0,57 e intraobservador de κ = 0,22, IC 95% 0,20-0,24. Conclusão: No presente estudo, o sistema de classificação de Weiss mostrou concordância maior do que a classificação Milch; contudo, esta última pode exigir estudos complementares, como artrografia, para ampliar a acurácia da classificação. Nível de Evidência II, Estudos Diagnósticos - Investigação de um Exame para Diagnóstico.
ABSTRACT
BACKGROUND: Implant-based immediate breast reconstruction after skin-sparing mastectomy has shown a significant improvement in patients' quality of life, making the procedure steadily more popular year after year. However, this technique has a high morbidity rate, including skin necrosis and implant exposure. METHODS: A retrospective review of a prospectively held database for autologous breast reconstruction in our institution of the last 5 years found eight cases with exposed implants after nipple-sparing mastectomy and immediate reconstruction. A single-stage procedure consisting on implant removal and immediate replacement with a deepithelialized DIEP flap was performed in all cases (10 DIEP flaps). RESULTS: All flaps were successful. Patients' mean age was 45 years old. Three patients developed seroma (5, 7, and 14 days after surgery, respectively). No infections were detected in up to 24 months of follow-up. CONCLUSIONS: Nipple-sparing mastectomy with immediate implant-based reconstruction is considered oncologically safe. However, it has a high rate of complications that could require implant removal. Immediate free flap reconstruction is a feasible and safe option to replace the missing volume with low risk of complications that result in a soft and natural-shaped breast.