Computed Tomography Does Not Improve Intra- and Interobserver Agreement of Hertel Radiographic Prognostic Criteria.

Background and Objectives: Proximal humerus fractures are the second most frequent site of avascular necrosis (AVN), occurring in up to 16% of cases. The Hertel criteria have been used as a reference for the prediction of humerus head ischemia. However, these are based solely on the use of radiographs, which can make interpretation extremely difficult due to several reasons, such as the overlapping fragments, severity of the injury, and noncompliant acute pain patients. The objectives of the study were to evaluate the role of computed tomography (CT) in the interpretation of the Hertel criteria and to evaluate the intra- and interobserver agreement of orthopedic surgeons, comparing their area of expertise. Materials and Methods: The radiographs and CT scans of 20 skeletally mature patients who had fractures of the proximal humerus were converted to jpeg and mov, respectively. All images were evaluated by eight orthopedic surgeons (four trauma surgeons and four shoulder surgeons) in two different occasions. The intra- and interobserver agreement was assessed by using the Kappa coefficient. The level of significance was 5%. Results: There was a weak-to-moderate intraobserver agreement (κ < 0.59) for all examiners. Only the medial metaphyseal hinge greater than 2 mm was identified by 87.5% of evaluators both in the radiographic and CT examinations in the two rounds of the study (p < 0.05). There was no significant interobserver agreement (κ < 0.19), as it occurred only in some moments of the second round of evaluation. Conclusions: The prognostic criteria for humeral head ischemia evaluated in this study showed weak intra- and interobserver agreement in both the radiographic and tomographic evaluation. CT did not help surgeons in the primary interpretation of Hertel prognostic criteria used in this study when compared to the radiographic examination.

ANALYSIS ON THE MODIFIED LYSHOLM FUNCTIONAL PROTOCOL AMONG PATIENTS WITH NORMAL KNEES.

OBJECTIVE: To evaluate the modified Lysholm protocol among patients with knees that were considered to be normal (without previous complaints or pathological conditions in this region). METHOD: Between January 2010 and March 2010, a prospective study was conducted on 300 patients with orthopedic complaints in other regions of the body who came to the emergency service of our hospital. The inclusion criterion among these patients was the absence of complaints or previous surgery in the knee that was considered to be dominant. The age range was from 16 to 40 years, with an average of 28.8 years. Our study group consisted of 153 males and 147 females. In the modified Lysholm system, the maximum score is 100 points and this includes functional and objective criteria. Altogether, 50% of the total score is based on symptoms of pain and instability. RESULTS: The average score using the Lysholm protocol was 95 points in the knees that were considered normal. Males had higher scores than females. CONCLUSION: These patients with knees that were considered normal did not achieve the maximum score when evaluated using the modified Lysholm protocol. This study suggests that this line of research on functional evaluation systems for the knee is open for further evaluations. Moreover, creation and development of new forms of functional assessment for the knee should be investigated in order to achieve a worldwide consensus.

Análise do protocolo funcional de Lysholm modificado em pacientes com joelhos normais / Analysis on the modified Lysholm functional protocol among patients with normal knees

OBJETIVO: Avaliar o protocolo de Lysholm modificado em pacientes com joelhos considerados normais (sem queixas ou doenças prévias nessa região). MÉTODO: No período de janeiro a março de 2010, foi realizado um estudo prospectivo com 300 pacientes que compareceram à emergência de nosso hospital com queixas ortopédicas em outras regiões do corpo. O critério de inclusão dos pacientes foi ausência de queixas ou cirurgia prévia no joelho considerado dominante. O limite de idade foi entre 16 e 40 anos, com média de 28,8 anos. Nossa pesquisa foi composta de 153 pacientes do sexo masculino e 147 pacientes do sexo feminino. No sistema Lysholm a pontuação máxima é de 100 pontos e inclui critérios funcionais e objetivos. Ao todo, 50 por cento do total do escore é baseado nos sintomas de dor e instabilidade. RESULTADOS: A média do protocolo de Lysholm foi de 95 pontos em joelhos considerados normais. O sexo masculino obteve um escore superior quando comparado ao sexo feminino. CONCLUSÃO: Os pacientes com joelho considerado normal não obtiveram a pontuação máxima na avaliação pelo protocolo modificado de Lysholm. O estudo sugere que esta linha de pesquisa sobre o sistema de avaliação funcional do joelho encontra-se aberta para novas avaliações. Assim como também devemos pesquisar a criação e a elaboração de novos formulários de avaliação funcional do joelho para a obtenção de um consenso mundial.

OBJECTIVE: To evaluate the modified Lysholm protocol among patients with knees that were considered to be normal (without previous complaints or pathological conditions in this region). METHOD: Between January 2010 and March 2010, a prospective study was conducted on 300 patients with orthopedic complaints in other regions of the body who came to the emergency service of our hospital. The inclusion criterion among these patients was the absence of complaints or previous surgery in the knee that was considered to be dominant. The age range was from 16 to 40 years, with an average of 28.8 years. Our study group consisted of 153 males and 147 females. In the modified Lysholm system, the maximum score is 100 points and this includes functional and objective criteria. Altogether, 50 percent of the total score is based on symptoms of pain and instability. RESULTS: The average score using the Lysholm protocol was 95 points in the knees that were considered normal. Males had higher scores than females. CONCLUSION: These patients with knees that were considered normal did not achieve the maximum score when evaluated using the modified Lysholm protocol. This study suggests that this line of research on functional evaluation systems for the knee is open for further evaluations. Moreover, creation and development of new forms of functional assessment for the knee should be investigated in order to achieve a worldwide consensus.