The objective of this study was to evaluate the accuracy of Board-certified specialist veterinary surgeons in assessing reduction of lateral humeral condylar fractures (HCFs) using orthogonal radiographs and to determine how often immediate surgical revision is recommended in order to correct a perceived malreduction. This was an ex-vivo study of 21 elbows from 11 skeletally mature canine cadavers. Lateral HCFs were surgically created and repaired with either anatomical or malreduced fixation (1-, 2-, or 3-mm step-offs in both distal and caudal directions). Fourteen Board-certified surgeons assessed postoperative radiographs to determine reduction quality and the need for immediate revision surgery. It was determined that surgeons frequently misclassified malreduced fractures, particularly those with caudal malreduction. Overall, 1-mm defects were misclassified at a rate of 24%, 2-mm defects at 34%, and 3-mm defects at 28%. Distal malreductions, especially those ≥ 2 mm, were more likely to be identified and recommended for immediate revision. Overall, 25% of 1-mm step-offs, 54% of 2-mm step-offs, and 45% of 3-mm step-offs were recommended for immediate revision. There was limited intraobserver consistency, with perfect accuracy and consistent reoperation advice achieved in 51% and 26% of distal and caudal malreductions, respectively. It was concluded that standard radiographs may not allow reliable detection of HCF malreductions, especially in the caudal direction. The reported outcome of HCF surgical repair might therefore be influenced by reduction misclassification.
Hart et al. (Thu,) studied this question.