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Article
Peer-Review Record

Pediatric Supracondylar Fracture of the Humerus with Sideward Displacement

Surg. Tech. Dev. 2023, 12(3), 107-118; https://doi.org/10.3390/std12030010
by Michael Zaidman 1, Mark Eidelman 2, Khaled Abu-Dalu 2 and Pavel Kotlarsky 2,*
Reviewer 1: Anonymous
Reviewer 2: Anonymous
Surg. Tech. Dev. 2023, 12(3), 107-118; https://doi.org/10.3390/std12030010
Submission received: 23 May 2023 / Revised: 18 June 2023 / Accepted: 29 June 2023 / Published: 30 June 2023

Round 1

Reviewer 1 Report

The article is a retrospective evaluation of patients under 14 that underwent on a surgical procedure for supracondylar humerus fracture (type II and III). A total of 17 patients presenting with a specific subtype of supracondylar fracture, with just a translational displacement (on AP view) were selected. The sample seems quite small. The topic is very interesting, the language is well taken care of, however I believe that some points should be reviewed:

- Study limitations are not adequately described

- For the sake of completeness, I suggest to add something more about the surgical approach, evaluating the use of the supine one. i.e. : “Sapienza M, Testa G, Vescio A, Panvini FMC, Caldaci A, Parisi SC, Pavone V, Canavese F. The Role of Patient Position in the Surgical Treatment of Supracondylar Fractures of the Humerus: Comparison of Prone and Supine Position. Medicine (Kaunas). 2023 Feb 15;59(2):374. doi: 10.3390/medicina59020374. PMID: 36837576; PMCID: PMC9963727.”

- if you have had anyone of them, complications are not well highlighted. Maybe I would compare the post operative complications related to the ones of the standard surgical treatment in the supine approach.

Minor corrections are due.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 2 Report

Dear Author,

Thank you for the opportunity to review this article.

 

Introduction

Supracondillary fractures are very common findings in a pediatric orthopedic surgeon's activity and the fracture patterns may vary indefinitely.

When describing fracture incidence and classification, laterality is also important to be noted. Here is an article with a similar incidence of supracondillary fractures assessing the laterality of fractures regarding hand dominance  that may be useful to include as a reference in the Introduction: https://doi.org/10.3390/children8010051

Lines 41-42: Positive diagnosis for a supracondylar humerus fracture consists of clinical and radiological assesment. Describing clinical evaluation of a broken elbow should be part of your introduction, including also diferential diagnosis with other post-traumatic types of deformed and swollen elbows, such as fractures arround the elbow, nursemaid's elbow ( https://link.springer.com/article/10.4103/ortho.IJOrtho_442_17 ), compartment syndrome, volkmann syndrome, etc.

Materials and Methods / Results

It seems that the fracture in your pictures is type IIIB by Gartland, although the extension is very hard to see. By the anterior humeral line, you let it in a slight extension after pinning. You also left a residual rotation. And also, the pins are passed through the supracondylar fossa of the humerus, instead of through the pillars. Maybe find and replace with a corect image?

Do you have long-term follow-up photos or clinical assessments to demonstrate the efficacy of the treatment? How much rotation you deem to be acceptable in such cases, knowing that remodelling is lesser in distal humerus?

A clinical score should be useful in post-op evaluation. Or measuring the carrying angle at 1-2 years post-op.

Discussions

Should include strenghts and weak points of your study, but also refferences to what further studies should look into for things that were not covered by your paper.

Conclusions

Conclusions should be a separate chapter, limited to 3 main ideas that are outcomes from your study, and that could change the medical practice for an pediatric orthopedist.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 3 Report

The paper describes a subtype supracondylar humerus fracture in pediatric patients, namely those with sideward displacement. Congratulations with your work. However, the paper rather presents a clinical observation along with a technique description than a formal research study. Therefore, I feel it is more suitable as a short communication or technique paper.

Some other general thoughts:

- The manuscipt is very narrative; try and shorten it so the message is delivered more concisely.

- The definition of the subtype (line 110) includes the AHL through anterior third of capitellum, which suspects an additional extension component

- describing the trauma mechanism of this fracture type would be informative

- Fig 3: the distal fragment is displaced laterally instead of medially

- again, providing patient outcomes would be of added value

Thank you for the opportunity to review the paper.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Ok,  the manuscript has been sufficiently improved.

Reviewer 3 Report

Thank you for addressing the questions and revising the paper.

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