Correlation Of Radiographic Diagnosis And Surgical Findings Of Upper Limb Fractures Among Children At Moi Teaching And Referral Hospital,

International Journal of Research and Innovation in Social Science (IJRISS) | Volume VI, Issue II, February 2022 | ISSN 2454–6186

Correlation Of Radiographic Diagnosis And Surgical Findings Of Upper Limb Fractures Among Children At Moi Teaching And Referral Hospital

Obe Bwami¹, Gabriel Onditi Elias^2*, Neford. Ongaro^3
1Department of Radiology and Imaging, Moi University, Kenya
²Department of Radiology and Imaging, Moi University. Kenya
³Directorate of orthopaedics, Moi teaching and referral hospital, Kenya,
*Corresponding author

Abstract
Purpose: The purpose of this study was to determine the level of agreement between radiology and surgery in children with upper limb fractures at Moi Teaching and Referral Hospital (MTRH).
Materials and Methods: A cross-sectional study was conducted on children presenting with upper limb fractures at the paediatric and orthopaedic emergency departments of Moi Teaching and Referral Hospital,Eldoret, Kenya. A total of 148 children were recruited by consecutive sampling between July 2019 and July 2020. Radiographs conducted at Moi Teaching and Referral Hospital were reviewed and used to make diagnosis. In addition, diagnoses made by the surgery team were recorded for each child. Descriptive statistics were used to provide a summary of the data obtained. Continuous data was summarized using measures of central tendency (mean and median) and measures of dispersion (standard deviation and interquartile range). The Cohen’s Kappa statistic was used to assess the level of agreement of diagnostic findings between radiology and surgery.
Results: The study participants were predominantly male (68.9%), had a mean age of 7 (SD=3.2) years of which majority (54.7%) were aged 5-9 years. Falls were the major injury mechanism accounting for 90.5% of the injuries while the accidents and cuts cumulatively accounted for less than 10% of the injuries. The most common fracture types were transverse by radiography (54.1%) compared to surgery (52.7%) and oblique fractures at 29.7% by radiography and 32.4% by surgery. Segmented fractures were reported in 5.4% of the study participants by surgery and in 1.4% by radiography while green-stick, spiral and comminuted fracture types were the least observed. Fractures of the supracondylar humerus were the most common by both radiography (69.4%) and surgery (67.6%). The second most observed fractures were phalanx at 8.8% by both radiography and surgery. The level of agreement between radiography and surgery was 95.5% with the Cohen’s Kappa statistic showing an almost perfect level of agreement (k=0.921, p-value<0.001).
Unique contribution to theory, practice and policy: Radiography is essential in the accurate diagnosis of paediatric fractures, and its continued use is of great value in patients’ management.

Key words: Radiographic Findings, Surgical Findings, Upper limb Fractures, Moi Teaching and Referral Hospital (MTRH)

1 INTRODUCTION

Published reports have indicated that fractures are a common occurrence in childhood traumatic events with considerable variations in the incidence rate from 1.2% to 5% among different studies (Elbaih et al., 2016). In this population, upper-extremity fractures account for more than half of the reported bony injuries whereby the frequency of these injuries increases with increasing mobility. The most common mechanism is a fall on an outstretched hand while playing (Arora et al., 2014).
There are certain types of fractures which can easily be missed during patient assessment in the initial radiological reports (Wei et al., 2006). In a systematic review, Wei et al., (2006) reported an overall prevalence of 3.7% of missed fractures whereby the most common locations were foot (7.6%), followed by the knee (6.3%), elbow (6.0%), hand (5.4%), wrist (4.1%), hip (3.9%), ankle (2.8%), and shoulder (1.9%). Similarly, Adams (2020) stated that fractures which are easily subject to misinterpretation are those that occur on the elbows, hands, wrists and shoulders.

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