Reliability and Validity of Radiographic Measurement of the Humerus-Elbow-Wrist Angle in Healthy Children

Abstract

UpdateThis article was updated on May 4, 2017, because of a previous error. The proximal line drawn in Figure 1 was different from the line described in the Materials and Methods section, which reads “The proximal line was drawn at the level of the radial tuberosity, and the distal line was made at the level of the top of the radial bowing (Fig. 1).” The correct figure is presented in this version of the article.An erratum has been published: JBJS Open Access. 2017 May 26;2(2):e0012ER.Background:We conducted a retrospective cohort study to evaluate the normal value, range, reliability, and validity of measurement of the humerus-elbow-wrist angle, an index of valgus-varus angulation of the elbow, in healthy children. This measurement has been used to assess postoperative radiographic results.Methods:Radiographs of the elbow in 62 healthy children ranging from 2 to 11 years of age were reviewed by 6 examiners at 2 sessions. The mean value and the reliability of measurement of the humerus-elbow-wrist angle, the carrying angle, and the Baumann angle were assessed. Intraobserver and interobserver reliability were calculated with use of intraclass correlation coefficients (ICCs). To determine concurrent validity, the association between the humerus-elbow-wrist angle and carrying angle measurements was examined with use of Pearson correlation coefficients.Results:The mean humerus-elbow-wrist angle value was 12.0° (range, 1° to 24°), and the mean carrying angle was 14.6° (range, 4° to 28°). The ICCs for intraobserver measurements of the humerus-elbow-wrist angle were almost perfect for 4 examiners and were substantial for 2 examiners, with a mean value of 0.85 (range, 0.73 to 0.94). The ICCs for interobserver reliability with regard to the first and second measurements of the humerus-elbow-wrist angle were both substantial (0.76 and 0.78). A significant association between the humerus-elbow-wrist angle and the carrying angle was observed, with the Pearson correlation coefficients ranging from 0.74 to 0.90 (p < 0.001).Conclusions:Measurement of the humerus-elbow-wrist angle demonstrated good reliability and validity. The humerus-elbow-wrist angle is a reliable radiographic measure of coronal alignment of the humerus and forearm.

Reliability of radiographic measurement of lateral capitellohumeral angle in healthy children

“…Exclusion criteria of the previous study were adapted for this study: radiographs that did not include coronal landmarks needed for measurement were excluded. [ 3 ] A senior resident (MH), who did not participate in the measurement, reviewed medical records and radiographs of the 75 patients and enrolled radiographs according to the criteria.…”

“…Humerus-elbow-wrist angle (HEWA), carrying angle (CA), and Baumann angle (BA) in the coronal plane, or shaft condylar angle, humerocapitellar angle, anterior humeral line, and coronoid line in the sagittal plane commonly have been used to assess angular deformity of the elbow. [ 1 – 3 ] Recently, the intraobserver reliability and interobserver reliability of HEWA, CA, and BA measurements have been demonstrated. [ 2 – 7 ] On the contrary, limited data are available to assess the reliability of measurements of radiographic parameters in the sagittal plane.…”

Medial Epicondyle Fracture in Children and Its Association with Increased Carrying Angle

“…We measured the radiographic CA instead of the clinical CA because it is more precise and reliable than the clinical measurement [ 24 ]. The HEWA has recently been adopted for the radiographic assessment of the coronal plane alignment of the elbow because the HEWA has good reliability and validity [ 10 , 25 ]. The mean HEWA and CA were significantly increased in patients with medial epicondyle fracture compared to those with supracondylar fracture (17.6° ± 2.8° vs 14.3° ± 3.6°, p =0.001, and 13.1° ± 2.8° vs 10.0° ± 3.8°, p =0.003).…”

“…The HEWA is the angle between the longitudinal axis of the humeral shaft and a line passing through the midpoints of 2 transverse lines across the forearm. The proximal line was drawn at the level of the radial tuberosity, and the distal line was drawn at the level of the top of the radial bowing ( Figure 1 ) [ 10 ].…”

Korrekturosteotomie des distalen Humerus und Unterarms – eine praktische Übersicht

“…Nonunion of the radial or ulnar condyle leads to severe arthrosis of the affected elbow joint, resulting in pain, loss of motion, and handicap in daily life and professional activities [8]. Chronic missed Monteggia deformity inevitably results in loss of flexion, forearm rotation, and arthritic deformity of the radiocapitellar joint [9][10][11][12][13][14]. In all cases, clinical history may reveal pain, stiffness, loss of motion, loss of strength, disability, and visible cosmetic changes.…”