Displaced supracondylar humeral fractures: influence of delay of surgery on the incidence of open reduction, complications and outcome

PurposeThe effect of surgical specialty on the outcomes of paediatric patients treated for displaced supracondylar humeral fractures remains unclear. The results of residents, paediatric surgeons and orthopaedic surgeons were compared.MethodsA retrospective review of 108 children (0 to 16 years) treated for displaced humeral supracondylar fractures (Gartland II or III) requiring closed or open reduction under general anaesthesia were included. The patient charts and radiographs were evaluated to identify type, grade and neurovascular complications. Operative performance (operative time, quality of reduction, need for open reduction, complications) of residents, paediatric surgeons and orthopaedic surgeons were evaluated.ResultsResidents used a crossed pin configuration for patients in 25/25 (100%), paediatric surgeons in 25/32 (78%) and orthopaedic surgeons in 33/33 (100%) (p = 0.0011). Loss of reduction was present in one patient treated with crossed pins, in two with lateral pins and in two without Kirschner-wires (p = 0.0034). The risk ratio of an unacceptable reduction was 4.0 (95% confidence interval (CI) 0.90 to 18, p = 0.070) for residents and 6.6 (95% CI 1.6 to 27, p = 0.0082) for paediatric surgeons as compared with orthopaedic surgeons. Complications were present in 37% of patients (11/30) for residents, 55% (24/44) for paediatric surgeons and 15% (5/34) for orthopaedic surgeons (p = 0.0013).ConclusionWe found statistically significant differences in the incidence of unacceptable reduction, complications and the usage of crossed pin configuration between the surgical specialties. Patients would benefit from the practice of assigning the operative treatment of displaced supracondylar fractures to orthopaedic surgeons.Level of evidence:Level III

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Temporary Use of Skeletal Traction in Management of Pediatric Supracondylar Humeral Fractures

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.6052 ◽

2020 ◽

Vol 22 (6) ◽

pp. 427-436

Author(s):

Piotr Zając ◽

Piotr Zając

Keyword(s):

Closed Reduction ◽

Open Reduction ◽

Treatment Algorithm ◽

Vascular Complications ◽

Humeral Fractures ◽

Percutaneous Fixation ◽

Skeletal Traction ◽

Fractures In Children ◽

Wire Fixation ◽

Supracondylar Humeral Fractures

Background. The paper presents a treatment algorithm for supracondylar humeral fractures in children, involving temporary use of skeletal traction following failure of primary closed reduction and percutaneous fixation (CRPF) and introducing closed reduction after management by skeletal traction. The aim of this study was to assess the outcomes of supracondylar humerus fracture treatment performed according to the algorithm. Material and methods. The treatment was performed in 149 children (70 girls, 79 boys) with extension-type supracondylar humeral fractures. The study group was assessed with regard to a modified Gartland classification, neurological complications (12 children, 8%) and vascular complications (8 children, 5.4%). A total of 124 (83.2%) patients underwent emergency CRPF and 24 children (16.1%) received skeletal traction after a failed CRPF. After 2-6 days, an elective repeat CRPF procedure was attempted, which was successful in 17 children. The attempt failed in the other 7 children, who received traction and underwent open reduction under a single anesthesia. One child (0.7%) with a white and pulseless hand was treated by emergency open reduction and percutaneous fixation. Results. The study used the Flynn criteria modified by the author. After 6 months, the results in the group treated with CRPF (both primary and following skeletal traction) were good in 90.8% of patients, satisfactory in 8.5%, and poor in 0.7%, whereas in the open reduction and percutaneous fixation group, the results were good in 87.5% of cases and satisfactory in 12.5%. Conclusions. 1. X-ray-guided closed reduction and percutaneous K wire fixation is a method of choice in the treatment of displaced supracondylar humeral fractures in children. If closed reduction fails, the surgeon is faced with a choice between primary open reduction and the use of direct traction through the olecranon. 2. The use of skeletal traction following failure of primary emergency CRPF results in local improvement in the fracture region and allows for scheduling an elective repeat delayed closed reduction and percutaneous K wire fixation procedure. 3. The algorithm used in clinical practice, based on literature reports and the author’s experience, helps achieve good treatment outcomes.

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Displaced supracondylar humeral fractures in children: open reduction vs. closed reduction and pinning

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-004-0730-1 ◽

2004 ◽

Vol 124 (8) ◽

pp. 547-551 ◽

Cited By ~ 57

Author(s):

G�rkan �zkoc ◽

Ugur Gonc ◽

Asim Kayaalp ◽

Kursat Teker ◽

Tulay Tuncer Peker

Keyword(s):

Closed Reduction ◽

Open Reduction ◽

Humeral Fractures ◽

Fractures In Children ◽

Supracondylar Humeral Fractures

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Open Reduction of Displaced Pediatric Supracondylar Humeral Fractures Through the Anterior Cubital Approach

Journal of Pediatric Orthopaedics ◽

10.1097/01.bpo.0000153725.16113.ab ◽

2005 ◽

Vol 25 (2) ◽

pp. 149-153 ◽

Cited By ~ 31

Author(s):

Sadan Ay ◽

Metin Akinci ◽

Sinan Kamiloglu ◽

Omer Ercetin

Keyword(s):

Open Reduction ◽

Humeral Fractures ◽

Supracondylar Humeral Fractures

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Early versus delayed surgery for paediatric supracondylar humeral fractures in the absence of vascular compromise

The Bone & Joint Journal ◽

10.1302/0301-620x.100b12.bjj-2018-0982.r1 ◽

2018 ◽

Vol 100-B (12) ◽

pp. 1535-1541 ◽

Cited By ~ 7

Author(s):

L. Farrow ◽

A. D. Ablett ◽

L. Mills ◽

S. Barker

Keyword(s):

Open Reduction ◽

Meta Analysis ◽

Risk Of Bias ◽

Humeral Fractures ◽

Perioperative Outcomes ◽

Inclusion Criteria ◽

Delayed Surgery ◽

Significant Difference ◽

Vascular Compromise ◽

Supracondylar Humeral Fractures

Aims We set out to determine if there is a difference in perioperative outcomes between early and delayed surgery in paediatric supracondylar humeral fractures in the absence of vascular compromise through a systematic review and meta-analysis. Materials and Methods A literature search was performed, with search outputs screened for studies meeting the inclusion criteria. The groups of early surgery (ES) and delayed surgery (DS) were classified by study authors. The primary outcome measure was open reduction requirement. Meta-analysis was performed in the presence of sufficient study homogeneity. Individual study risk of bias was assessed using the Risk of Bias in Non-Randomised Studies – of Interventions (ROBINS-I) criteria, with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria used to evaluate outcomes independently. Results A total of 12 studies met the inclusion criteria (1735 fractures). Pooled mean time to surgery from injury was and 10.7 hours for ES and 91.8 hours for DS. On meta-analysis there was no significant difference between ES versus DS for the outcome of open reduction requirement. There was also no significant difference for the outcomes: Iatrogenic nerve injury, pin site infection, and re-operation. The quality of evidence for all the individual outcomes was low or very low. Conclusions There is no evidence that delaying supracondylar fracture surgery negatively influences outcomes in the absence of vascular compromise. There are, however, notable limitations to the existing available literature.

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