Aims To propose a new method for evaluating paediatric radial neck fractures and improve the accuracy of fracture angulation measurement, particularly in younger children, and thereby facilitate planning treatment in this population. Methods Clinical data of 117 children with radial neck fractures in our hospital from August 2014 to March 2023 were collected. A total of 50 children (26 males, 24 females, mean age 7.6 years (2 to 13)) met the inclusion criteria and were analyzed. Cases were excluded for the following reasons: Judet grade I and Judet grade IVb (> 85° angulation) classification; poor radiograph image quality; incomplete clinical information; sagittal plane angulation; severe displacement of the ulna fracture; and Monteggia fractures. For each patient, standard elbow anteroposterior (AP) view radiographs and corresponding CT images were acquired. On radiographs, Angle P (complementary to the angle between the long axis of the radial head and the line perpendicular to the physis), Angle S (complementary to the angle between the long axis of the radial head and the midline through the proximal radial shaft), and Angle U (between the long axis of the radial head and the straight line from the distal tip of the capitellum to the coronoid process) were identified as candidates approximating the true coronal plane angulation of radial neck fractures. On the coronal plane of the CT scan, the angulation of radial neck fractures (CTa) was measured and served as the reference standard for measurement. Inter- and intraobserver reliabilities were assessed by Kappa statistics and intraclass correlation coefficient (ICC). Results Angle U showed the strongest correlation with CTa (p < 0.001). In the analysis of inter- and intraobserver reliability, Kappa values were significantly higher for Angles S and U compared with Angle P. ICC values were excellent among the three groups. Conclusion Angle U on AP view was the best substitute for CTa when evaluating radial neck fractures in children. Further studies are required to validate this method.

中文翻译：

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基于Judet分级的桡骨颈骨折评估新方法


目的 提出一种评估儿童桡骨颈骨折的新方法，并提高骨折角度测量的准确性，特别是对于年幼的儿童，从而有助于规划该人群的治疗。方法收集2014年8月至2023年3月我院收治的117例桡骨颈骨折患儿的临床资料。共有 50 名符合纳入标准的儿童（26 名男性，24 名女性，平均年龄 7.6 岁（2 至 13 岁））进行了分析。病例因以下原因被排除：Judet I 级和 Judet IVb 级（> 85° 角度）分类；射线照相图像质量差；临床信息不完整；矢状面角度；尺骨骨折严重移位；和孟氏骨折。对于每位患者，获取标准肘部前后位 (AP) 射线照片和相应的 CT 图像。在射线照片上，角度 P（与桡骨头长轴与垂直于骨骺线之间的角度互补）、角度 S（与桡骨头长轴与通过近端桡骨轴的中线之间的角度互补） ）和角度 U（桡骨头长轴与从小头远端到冠突的直线之间）被确定为近似桡骨颈骨折真实冠状面角度的候选角度。在CT扫描的冠状面上测量桡骨颈骨折（CTa）的成角，并作为测量的参考标准。通过 Kappa 统计和组内相关系数 (ICC) 评估观察者间和观察者内的可靠性。结果 U 角与 CTa 的相关性最强 (p < 0.001)。 在观察者间和观察者内部的可靠性分析中，与角度 P 相比，角度 S 和 U 的 Kappa 值显着更高。三组中的 ICC 值均优异。结论 在评估儿童桡骨颈骨折时，AP 切面 U 角是 CTa 的最佳替代方案。需要进一步的研究来验证该方法。