LAUSR

below. Miller et al1 found that ultrasound was as specific but not as sensitive as magnetic resonance imaging in evaluating epicondylitis in 11 patients with a mean age of 46 years. However, epicondylitis is considerably different from pediatric lateral humeral condyle fractures. Changes in tendons are of concern for cases of epicondylitis, but cartilage integrity is of concern for pediatric lateral humeral condyle fractures. Currently, it is not conclusive whether ultrasound or magnetic resonance imaging is more reliable in diagnosing pediatric lateral humeral condyle fractures. Our team is studying this issue, and the relevant research results will be published in the near future. We hope that Dr Sunny Chaudhary will read our future publication if he is interested in this issue. We would like to highlight that the significant differences between the kappa values were usually present when the upper and lower boundaries of the 95% confidence interval did not overlap.2 In this study, the level of interobserver reliability was moderate, with no significant difference between the two rounds of treatments. Moreover, due to the lack of a unified standard for determining the need for additional examinations, the kappa value fluctuated significantly in the 2 rounds of evaluation. Intraobserver reliability refers to the agreement between the measures determined by the same observer in 2 rounds of evaluation. The observers received additional training on ultrasound image interpretation but not on x-ray image interpretation between the 2 rounds of evaluation. Therefore, the intraobserver reliability based on the x-ray images may be higher than that based on both the x-ray images combined with ultrasound images. We did not find the “3 values in x-ray group and 4 values in x ray+ US group” mentioned by the Dr Sunny Chaudhary in table 4. We suppose that Dr Sunny Chaudhary may be referring to table 3. Some measures of intraobserver reliability were not assessed by statistical tests because some of the data we collected were continuous. It is a good suggestion to separately calculate the proportion of treatment plan changes from the original plans for surgical treatment and conservative treatment. This may be another way to illustrate the changes in the treatment plans after the addition of ultrasound images. The discussion section of the paper clearly states, “A total of 57% of treatment plans were changed to not requiring further examination after the addition of ultrasound images in the second round of evaluation.” Obviously, the main conclusion of the study is that the number of cases that changed to not requiring further examination (57%) was significantly larger than the number of cases that changed to requiring further examination (4%) after with addition of ultrasound images in the second round of evaluation, rather than comparing the data from the first round of evaluation. Currently, ultrasonography is a useful technique that has been used to assist the diagnosis and treatment of pediatric lateral humeral condyle fractures in our institution, and we will continue to share our experience in using ultrasound for assessing pediatric lateral humeral condyle fractures in the future.