Author’s Reply to the Letter to the Editor regarding: “Severity of elbow mobility limitation in pediatric patients with a displaced supracondylar humerus fracture”

Dear Editor,

We thank the authors of the letter for their interest in our study and for their insightful comments. We would like to take this opportunity to clarify several methodological points.

To clarify the criteria for a “properly” performed procedure, we assessed the position of the fragments intraoperatively to ensure the anterior humeral line always intersected the central part of the capitellum. As stated in our article, Baumann’s angle was always compared with the contralateral limb, and any significant deviation was corrected. Likewise, no malrotation was tolerated, and any such case was addressed intraoperatively to achieve an anatomical rotational alignment.

Regarding the measurement of outcomes, we confirm that although not explicitly stated in the article, the range of motion in all patients was measured with a standard goniometer. In our practice, we consider the comparison of the range of motion of the operated limb with the contralateral side to be crucial. This procedure prevents possible misinterpretation of the results since, as the author of the letter correctly states, the physiological range of elbow motion is highly individual. The difference in the measured angles was then used to assign the patient to the appropriate category according to Flynn’s classification. We do, however, agree with the authors that the absence of raw data from these angle measurements is a limitation of our study. This is due to the retrospective nature of the work, as these data were not systematically and uniformly recorded in the original patient documentation and thus could not be used validly.

Regarding the choice of classification, we used the modified Gartland classification, which is the most widely recognized system globally for this type of fracture. ¹ In this classification, type II displacement is not subdivided into subtypes a and b. For our work, which focused primarily on the final functional outcome (range of motion), we consider this classification to be sufficient and fully in line with common clinical practice.

Note: There are many classification schemes for evaluating supracondylar fractures of the humerus. For example, the Havránek classification is used in the Czech Republic and Slovakia, which accounts for the great variability of these fractures.^2,3

We believe that these clarifications will contribute to a better interpretation of our results, and we thank you once again for the constructive discussion.