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Uh Hi, everyone. It's our pleasure today to present our ninth journal club meeting, this collaborative uh successful uh meeting between uh our oro be and our Egyptian orthotic castration. Today, we will present two nice paper by one of our uh two UK, Egyptian doctors. The first paper will be presented by our clique Mina A. It will be about ability and the validity of wearing to classification of elbow fracture dislocation. And second paper will be presented by our colleague Osman. It will be about the open fracture patient evaluation. Uh It's an open study. So uh Mina, if you can share from your side, please. Yes, please. Just one second. Yeah. Can you see my skin? Can you see my screen? Yeah, we can see your skin. OK. Should I start? Yes, doctor, please? OK. Hello. Hi. Hi, everybody. Uh My name is Mina A, I'm uh uh currently uh working uh in NHS uh as a uh for the card and university health board. I'm presenting today uh an article about reliability and validity of writing to classification of elbow fru dislocation. Uh It was done in August 2020 but published in August 2020. Uh with affiliation to writing to an upper limb unit in began UK. Uh the that was published in, was born in J journal, which is AQ one was the impact factor 4.6 and citation count and now is 19. Uh So in four years, uh there was 19 sorry, five years, there's now 19 citations. And yup. So let's see. So just um uh uh lecturer and uh I see a picture and now I'm in Deville. Uh So let's talk about reliability and validity about the title itself. So reliability uh is to get uh the target um like in a in a small area. So uh for reliability to, to, to, to say something is that, that is reliable. So when you hit something like uh for many times, it will be in a small area. So you just, your target is in a small area, this is reliable and validity is to hit the target itself. So like on the uh lower left side, this is reliable but not valid because they didn't hit the target, they are reliable but they are not valid. OK. So for our classification, for our classification to be to be uh used in uh orthopedics, it should be reliable and it should be valid. So, so for the as an introduction for the writing to classification itself, so elbow fracture dislocation are complex injuries with high risk uh of poor outcome. So the existing classification often target individual structure, either either of the ulna or radius. Uh But uh there is limiting comprehensive, with limited comprehensive manage for each uh classifications that we have currently, which we'll talk about it. Uh In shortly later. Uh So writing classification offers anatomical based and six subtype models based on the coronoid and ra head involvement uh with a suggestion of a treatment algorithm for each type. And the aim of this study that we're uh discussing today is to evaluate the reliability and the validity of this system using radiograph and CT data. So uh just uh uh to go quickly about the current classification. So as we said, there is no uh classification for elbow dislocation. So, so, so either the coronoid fracture uh classifications like classification or and the Mobi classification or there is a radial head classifications as mainstream classification orgs with Hodgkiss mo modification. And there is uh classification about the Monte or Monti variant which is be or jut classification uh like uh it is ju is like classification for type two in be classification. And there is uh another classification which is ring classification. So they all manage uh like only an individual uh structure or an individual type of uh classification with no um algorithm for treatment. So that's why the writing classification uh offers uh what is lacking in our classification now. And there's also the general uh like um what we call like general description of uh of, of elbow disc location, either a terrible triad or uh the posterior virus um subxi sub uh uh dis or uh the to dislocation which is not a classification itself, it was just uh like um naming the injury about it. So, but there is no classification for that. So the white offers, as we said uh this type of uh injury. So uh it depends on the column. So it divides the elbow in three columns. So the medial ulnar is one column, the lateral ulnar is the middle column and the medial head is the lateral column. And when uh there is uh disruption in these columns is dislocation happens. This is the same certification and it divides the uh the elbow dislocations into S uh six types. So A B uh CD and B plus and D plus. And uh as you see here, there was a suggestion of each type uh treatment algorithm for each type uh so quickly. So the subtype A is equivalent to the va posted rotatory injury type B. Uh And uh with uh B plus is a radial head injury. So this includes uh Monte variants and so one or disruption type C is a terrible tri as we know it. And type D is a distal ulna uh with uh like a again, a Monte variant. So, so to talk about this article, so how to validate a fraction classification system? So this is uh like a paper done by a bridge el framework, which is also uh mentioned in our literature as a reference. So they used to do to, to uh to say that our study or classification is reliable. So it has to be having inter observer uh reliability. So to ask, do different clinician agree uh uh at this classification and intraobserver, which means that uh one clinician uh assess the classification or that fracture type and I dey it correctly uh within uh like a time frame. And this is measured statistically by Kappa statistics uh validity. Uh it should be easy. So it says, does it accurately reflects the real fracture pattern? So if like uh say uh I will say this is vit classification type A. So is it actually type a or not? This is validity and we compare it to a gold standard uh as we see here as they used the interoperative findings uh as as gold standard, which is like uh no one can uh actually argue about it. So, and also for a classification to be used. So it has to be in expert agreement. So all experts use it and for it to be multicenter liability, not just uh uh like in UK, we use it and uh when we use it uh other elsewhere in the world, they uh say it's not reliable. So it has to be reliable in multicentre and to guide management, which is why we classify a fracture for uh for management, which is the important uh topic in fractures. So uh as a method for this study, they included 48 patients and reviewed by seven observers. The they were consultants, fellows and trainees. So they are different uh type of experience. So the, so the imaging was that all patients had radiographs and 44 had to DCT 79 had 3D reconstruction. OK. So they sent the uh the, so they, they give a CD with um radiographs to each observer.