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Familiari F, Zappia A, Gasparini G, Mercurio M, Tedesco G, Riccelli DA, Perticone L, Carlisi G, Testa G, Lucenti L, Pavone V, Vescio A. Pediatric Supracondylar Humerus Fracture: When Should We Surgically Treat? A Case-Series. J Clin Med 2025; 14:237. [PMID: 39797320 PMCID: PMC11721676 DOI: 10.3390/jcm14010237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 12/11/2024] [Accepted: 01/01/2025] [Indexed: 01/13/2025] Open
Abstract
Background/Objectives: Supracondylar humerus fractures (SCHFs) are the most common pediatric elbow injuries and often require surgical intervention. Despite guidelines, optimal timing for surgical management, particularly for cases without neurovascular compromise, remains unclear. This study evaluates the influence of surgical timing on short-term outcomes, focusing on fracture reduction quality and surgical parameters. Methods: In total, 62 pediatric patients who had been treated for Gartland type II and III SCHF between 2018 and 2023 were retrospectively assessed. Patients were grouped based on time of admission (morning, afternoon, early evening, and night shifts) and time to surgery (<12 h vs. >12 h). Primary outcomes included immediate radiological reduction, assessed via the Baumann's angle (BA) and shaft-condylar angle (SCA). Secondary outcomes encompassed surgery duration and radiation exposure. Statistical analyses used ANOVA and chi-square tests, with p < 0.05 considered significant. Results: No significant differences were observed in BA (p = 0.84) or SCA (p = 0.79) between early and delayed surgical groups. Similarly, surgical timing (shift or delay >12 h) did not significantly affect surgery duration (p = 0.92) or radiation exposure (p = 0.12). The complication rate was 6.45%. Conclusions: Surgical timing, including delays beyond 12 h, does not adversely affect short-term outcomes in SCHFs. However, after-hours procedures may pose practical challenges, emphasizing the importance of surgeon experience and institutional protocols. Larger prospective studies are warranted to validate these findings and examine them in the long term.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopedics, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.F.); (G.C.)
| | - Andrea Zappia
- Department of Orthopedics, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.F.); (G.C.)
| | - Giorgio Gasparini
- Department of Orthopedics, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.F.); (G.C.)
| | - Michele Mercurio
- Department of Orthopedics, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.F.); (G.C.)
| | - Giuseppe Tedesco
- Orthopedic and Traumatology Unit, Arnaldo Pugliese Hospital, Azienda Ospedaliero-Universitaria “Renato Dulbecco” di Catanzaro, Viale Pio X, 88100 Catanzaro, Italy; (G.T.); (D.A.R.); (L.P.); (A.V.)
| | - Daria Anna Riccelli
- Orthopedic and Traumatology Unit, Arnaldo Pugliese Hospital, Azienda Ospedaliero-Universitaria “Renato Dulbecco” di Catanzaro, Viale Pio X, 88100 Catanzaro, Italy; (G.T.); (D.A.R.); (L.P.); (A.V.)
| | - Livio Perticone
- Orthopedic and Traumatology Unit, Arnaldo Pugliese Hospital, Azienda Ospedaliero-Universitaria “Renato Dulbecco” di Catanzaro, Viale Pio X, 88100 Catanzaro, Italy; (G.T.); (D.A.R.); (L.P.); (A.V.)
| | - Giovanni Carlisi
- Department of Orthopedics, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.F.); (G.C.)
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (G.T.); (V.P.)
| | - Ludovico Lucenti
- Department of Orthopaedics and Traumatology, University of Palermo, 90133 Palermo, Italy;
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (G.T.); (V.P.)
| | - Andrea Vescio
- Orthopedic and Traumatology Unit, Arnaldo Pugliese Hospital, Azienda Ospedaliero-Universitaria “Renato Dulbecco” di Catanzaro, Viale Pio X, 88100 Catanzaro, Italy; (G.T.); (D.A.R.); (L.P.); (A.V.)
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Erdoğan F, Öztürk Ö, Cengiz T, Şimşek ŞA, Coskun HS, Dabak N. The Impact of Surgical Timing on Complications and Clinical Outcomes in Surgery for Displaced Pediatric Supracondylar Humerus Fracture. Ortop Traumatol Rehabil 2024; 26:257-263. [PMID: 40136091 DOI: 10.5604/01.3001.0055.0633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2025]
Abstract
BACKGROUND Pediatric supracondylar humerus fractures are common in children aged 5-7. The mechanism of injury, fracture type, and its relationship to the epiphysis significantly affect long-term outcomes. This study examines the impact of demographic data, fracture characteristics, and surgical timing and duration on postoperative results. MATERIAL AND METHODS Patients treated for supracondylar humerus fractures between February 2009 and January 2021 were included. Pre- and postoperative radiographs were analyzed, and surgical timing and duration were compared with fracture type and clinical outcomes. RESULTS A total of 121 patients (72 males, 49 females) at a mean age of 6.6 2.8 years were evaluated. The mean surgery duration was 50.1 29.2 minutes. Fractures were classified as Gartland type 2a (38 patients), type 2b (59 patients), and type 3 (24 patients). Closed reduction with percutaneous pinning was performed in 82 cases. Complications occurred in 7 patients with surgery delays of less than 8 hours and in 4 patients with delays over 8 hours. A significant correlation was found between surgical timing, hospital stay, and complications (p<0.05). The Flynn criteria indicated better outcomes in patients with surgery performed between midnight and 08 a.m. and within 8 hours of injury. CONCLUSIONS 1. Pediatric patients operated on during nighttime hours exhibited higher complication rates and longer hospital stays. 2. Outcomes assessed using the Flynn criteria were superior in patients operated on during daytime hours or with surgical waiting times of less than 8 hours. 3. These findings suggest that there is no universal definitive limit for optimal surgical timing. 4. Patient-specific conditions and clinical features should guide surgeons in determining the appropriate timing for surgery.
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Affiliation(s)
- Furkan Erdoğan
- Ondokuz Mayis University Faculty of Medicine, Department of Orthopedics and Traumatology, Samsun, Turkey
| | - Özkan Öztürk
- Amasya University Sabuncuoğlu Şerefeddin Training and Research Hospital, Department of Orthopedics and Traumatology, Amasya, Turkey
| | - Tolgahan Cengiz
- Inebolu State Hospital, Clinic of Orthopedics and Traumatology, Kastamonu, Turkey
| | - Şafak Aydın Şimşek
- Ondokuz Mayis University Faculty of Medicine, Department of Orthopedics and Traumatology, Samsun, Turkey
| | - Hüseyin Sina Coskun
- Ondokuz Mayis University Faculty of Medicine, Department of Orthopedics and Traumatology, Samsun, Turkey
| | - Nevzat Dabak
- Ondokuz Mayis University Faculty of Medicine, Department of Orthopedics and Traumatology, Samsun, Turkey
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Albrahim IA, AlOmran AK, Bubshait DA, Tawfeeq Y, Alumran A, Alsayigh J, Abusultan A, Altalib A, Alzaid ZA, Alsubaie SS, Alzahrani MM. Time of surgery and surgeon level in supracondylar humerus fractures in pediatric patients: A retrospective study. World J Orthop 2023; 14:791-799. [DOI: 10.5312/wjo.v14.i11.791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/18/2023] [Accepted: 10/08/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Supracondylar humerus fractures account for more than 60% of all elbow fractures and about 1/5 of all pediatric fractures. Unfortunately, these fractures can be associated with risk of complications including neurovascular injuries, malunions and limb deformities. Controversy exists regarding the effect of time of surgical intervention and/or level of surgeon performing the surgery on outcome of these fractures.
AIM To determine whether time of surgical intervention and/or surgeon level influence the outcomes of surgically managed pediatric supracondylar humerus fractures.
METHODS We retrospectively studied 155 pediatric patients presenting with a supracondylar humerus fracture in a level 1 trauma center from January 2006 to December 2019. The data extracted included demographic data, fracture characteristics, surgical data, and follow-up outcomes. The collected data was analyzed and P values of < 0.05 were considered statistically significant.
RESULTS Of the cohort, 11% of patients had documented post-operative complications, of which the majority occurred in surgeries performed after day time working hours and in fractures requiring open reduction. While the lowest complication rate was found in surgeries performed by pediatric orthopaedic surgeons, this did not reach statistical significance.
CONCLUSION In pediatric patients undergoing surgery for supracondylar fractures, we found a higher complication rate when surgeries were not performed during working hours. Surgeon level and training had no significant effect on the risk of post-operative complications.
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Affiliation(s)
- Ibrahim A Albrahim
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ammar K AlOmran
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Dalal A Bubshait
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Yaser Tawfeeq
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Arwa Alumran
- Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Jaffar Alsayigh
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ammar Abusultan
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Abdulraheem Altalib
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Zaid A Alzaid
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Shayma S Alsubaie
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mohammad M Alzahrani
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
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Muacevic A, Adler JR, Alsiddiky A. The Effect of Delayed Closed Reduction of Supracondylar Fracture on Perioperative Complications. Cureus 2022; 14:e32782. [PMID: 36686109 PMCID: PMC9855295 DOI: 10.7759/cureus.32782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Supracondylar fracture is one of the most frequent pediatric traumas and surgically managed fractures. Multiple factors can contribute to delaying surgical management of supracondylar fracture, which is thought to lead to difficult reduction and more complications. Surgical treatment during the nighttime shift (from 20:00-8:00) might increase the complication rate including vascular injury, nerve injury, and the need to convert closed reduction to open due to multiple reasons including nontrained staff, exhausted on-call team, and other reasons. Objectives We are looking into the effect of delaying surgical intervention 24 hours from the trauma to the surgical intervention and the impact of daytime or night-time surgeries on perioperative complications. Methods A retrospective cohort study was conducted on all patients who presented with supracondylar fracture Gartland type 2 or 3 who required surgical intervention (63 patients) from 2018-2021 in an academic institute. All patients presented with unilateral injury. Patients were divided into an early surgical group where the surgery was done within the first 24 hours from the trauma and a delayed surgical group if performed after 24 hours. Additionally, patients were classified based on the time of the day surgery was performed into daytime or nighttime surgeries. The complication rate was compared between the groups. Results Most of the patients were male, and the mean age was 4.52 ± 2.28 years. No significant difference was found between the early and delayed groups in the complication rate. Nerve and vascular injury were statistically higher for cases operated at nighttime. Conclusion Delayed surgical treatment of supracondylar fracture doesn't affect the complication rate, whereas closed reduction of supracondylar fractures that were performed during nighttime duty was shown to lead to a higher rate of vascular and nerve injuries.
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Abdelmalek A, Towner M, Clarke A. Are we staying up too late? Timing of surgery of displaced supracondylar fractures in children. Clinical audit in a paediatric tertiary UK trauma centre and literature review. Arch Orthop Trauma Surg 2022; 142:3863-3867. [PMID: 34999994 DOI: 10.1007/s00402-021-04289-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The British Orthopaedic Association (BOA) guidelines in managing supracondylar humerus fractures in children, outline indications for urgent fixation of these fractures. We present our data from a regional paediatric trauma centre before and after implementing a change in practice as per these guidelines. MATERIALS AND METHODS Retrospective clinical audit against BOA guidelines. Radiographs, admission clerking notes, operation notes, and clinic letters were all reviewed. We included all displaced supracondylar fractures of the extension type (Gartland Types 2b and 3). The first audit cycle occurred in 2017, subsequent cycles in 2018 & 2019. RESULTS 172 patients reviewed across the three audit stages. In the first audit, almost quarter of patients were operated on in the same night without clear indication as per the guidelines. This dropped down to 7% after a change of practice in 2019. Rate of conversion to open reduction and nerve complications did not increase after delayed fixation. CONCLUSION When there is no indication for same night operating out of hours, delaying treatment until the next day seems to be a safe way of treating these difficult fractures. Our data show that there is no increase in complications when these fractures are managed the next day.
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Affiliation(s)
- Amir Abdelmalek
- Southmead Hospital, Southmead Road, Bristol, BS10 5NB, England, UK.
| | - Matthew Towner
- Southmead Hospital, Southmead Road, Bristol, BS10 5NB, England, UK
| | - Anna Clarke
- Bristol Royal Children Hospital, Upper Maudlin Street, Bristol, BS2 8HW, England, UK
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Mahan ST, Miller PE, Park J, Sullivan N, Vuillermin C. Fully displaced pediatric supracondylar humerus fractures: Which ones need to go at night? J Child Orthop 2022; 16:355-365. [PMID: 36238148 PMCID: PMC9550999 DOI: 10.1177/18632521221119540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Challenges remain in determining which displaced supracondylar humerus fractures are safe to postpone surgical treatment until daylight hours. The purpose of this study is to determine which characteristics can be identified to guide the timing of treatment of supracondylar humerus fractures. METHODS 225 completely displaced Gartland extension type 3/4 supracondylar humerus fractures in healthy patients that presented between 6 am and 7 am were identified. Data were collected retrospectively. Data analysis included univariate, multivariable logistic regression and classification and regression tree analysis. RESULTS 5% (78/225) underwent surgical treatment the night they presented, while 65% (147/225) were treated the next day. Overall complication rate was 6%, with no difference based on timing of surgery. 12% (28/225) presented with a motor nerve injury, while 6% (14/225) a "pink pulseless" extremity. Statistical analysis found the most reliable radiographic predictor to be the maximum displacement on the anterior-posterior or lateral view. Classification and regression tree analysis developed a clinical algorithm; patients with a "pink pulseless" extremity or motor nerve injury were recommended for surgery overnight, while those with an anterior-posterior or lateral view < 25 mm were recommended for surgery the next day. CONCLUSION This study provides guidance on the timing of treatment for displaced supracondylar humerus fractures that present overnight. We provide a simple algorithm with three key clinical predictors for timing of treatment: presence of a "pink pulseless" arm, presence of a motor nerve injury, and displacement of any cortex by at least 25 mm (anterior-posterior or lateral view). This provides a step forward to help practitioners make safer evidenced-based timing decisions for their patients. LEVEL OF EVIDENCE Prognostic Study, Level II.
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Affiliation(s)
- Susan T Mahan
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Boston, MA, USA,Orthopaedic Surgery, Harvard Medical
School, Boston, MA, USA,Susan T Mahan, Department of Orthopaedic
Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
Email
| | - Patricia E Miller
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Boston, MA, USA
| | - Jiwoo Park
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Boston, MA, USA
| | - Nicholas Sullivan
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Boston, MA, USA
| | - Carley Vuillermin
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Boston, MA, USA,Orthopaedic Surgery, Harvard Medical
School, Boston, MA, USA
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Liebs TR, Lorance A, Berger SM, Kaiser N, Ziebarth K. Health-Related Quality of Life after Fractures of the Distal Forearm in Children and Adolescents—Results from a Center in Switzerland in 432 Patients. CHILDREN 2022; 9:children9101487. [PMID: 36291423 PMCID: PMC9601170 DOI: 10.3390/children9101487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: We aimed to evaluate the health-related quality of life (HRQoL) in children with fractures of the distal forearm and to assess if HRQoL was associated with fracture classification; (2) Methods: We followed up on 432 patients (185 girls, 247 boys) who sustained a fracture of the distal radius or forearm from 1/2007 to 6/2007, 1/2014 to 6/2014, and 11/2016 to 10/2017. Patients filled in the Quick-DASH (primary outcome) and the Peds-QL; (3) Results: The radius was fractured in 429 and the ulna in 175 cases. The most frequent injury of the radius was a buckle fracture (51%, mean age 8.5 years), followed by a complete metaphyseal fracture (22%, 9.5 years), Salter-Harris-2 fracture (14%, 11.4 years), greenstick fracture (10%, 9.3 years), Salter-Harris-1 fracture (1%, 12.6 years), and other rare injuries. The most common treatment was closed reduction and an above-elbow cast in 138 cases (32%), followed by a cast without reduction (30%), splint (28%), and K-wire fixation and cast (9%). Definite treatment was performed initially in 95.8%, a new cast or cast wedging was performed in 1.6%, and revision surgery was performed in 2.5%. There were no open reductions and no plate fixations. After a mean follow-up of 4.2 years, patients with buckle fractures had a mean Quick-DASH of 3.3 (scale of 0–100) (complete fracture: 1.5; greenstick: 1.5; SH-1: 0.9; SH-2: 4.1; others: 0.9). The mean function score of the PedsQL ranged from 93.0 for SH-2 fractures to 97.9 for complete fractures; (4) Conclusions: In this cohort of 432 children with fractures of the distal forearm, there was equally good mean mid- and long-term HRQoL when assessed by the Quick-DASH and the PedsQL. There was a trend for children with complete metaphyseal fractures reporting better HRQoL than patients with buckle fractures or patients with Salter-Harris II fractures, however, these differences were not statistically significant nor clinically relevant.
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Ismayl G, Kim WJ, Iqbal M, Sajid S. Early Versus Delayed Treatment for Gartland Type III Supracondylar Humeral Fractures in Children: A Systematic Review and Meta-analysis. Indian J Orthop 2022; 56:1871-1881. [PMID: 36092280 PMCID: PMC9450819 DOI: 10.1007/s43465-022-00734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/23/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The timing of treatment for Gartland type III supracondylar fractures has been an area of contention as it was previously thought to be a surgical emergency. The aim of this systematic review and meta-analysis is to clarify whether there is a difference in perioperative outcomes between early and delayed treatment for Gartland type III supracondylar humeral fractures in children. METHODS Literature search and study selection were performed according to the PRISMA process. The early surgery (ES) and delayed surgery (DS) groups were defined by the authors of each study included, based on the time to surgery. The primary outcome was the risk of conversion to open reduction. The secondary outcome was perioperative complication risks. RESULTS A total of 14 studies met the eligibility criteria (n = 1263 patients), of which 665 (52.7%) patients had undergone early surgery, while 598 (47.3%) had delayed surgery. On meta-analysis, there was no significant difference between ES and DS for the outcome of open reduction conversion risk. There was also no significant difference for the secondary outcomes of post-operative compartment syndrome, iatrogenic nerve injury, vascular injury, and surgical site infection. CONCLUSION Despite the limitations in the literature, evidence exists to support the notion that a delayed approach to the surgical treatment of Gartland type III supracondylar humeral fractures in children does not result in an increased risk of converting to open reduction and perioperative complications.
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Affiliation(s)
- G. Ismayl
- Trauma and Orthopaedics Department, Russell’s Hall Hospital, The Dudley Group NHS Foundation Trust, Pensnett Road, Dudley, DY1 2HQ UK
| | - W. J. Kim
- Trauma and Orthopaedics Department, Russell’s Hall Hospital, The Dudley Group NHS Foundation Trust, Pensnett Road, Dudley, DY1 2HQ UK
| | - M. Iqbal
- Trauma and Orthopaedics Department, Russell’s Hall Hospital, The Dudley Group NHS Foundation Trust, Pensnett Road, Dudley, DY1 2HQ UK
| | - S. Sajid
- Trauma and Orthopaedics Department, Russell’s Hall Hospital, The Dudley Group NHS Foundation Trust, Pensnett Road, Dudley, DY1 2HQ UK
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Gutwerk A, Behrendt P, Vetter S, Menzdorf L, Oates E, Jazra S, Lippross S, Klüter T, Seekamp A, Weuster M. Retrospective Mid-Term Follow-Up of Posttraumatic and Iatrogenic Neurovascular Complications in Surgically Treated Paediatric Patients with Distal Humerus Fracture. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1349. [PMID: 36138658 PMCID: PMC9497747 DOI: 10.3390/children9091349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of the study was to investigate and describe neurovascular complications and mid-term clinical outcomes of operatively managed fractures of the distal humerus in a paediatric population. Neurovascular injuries are common in these fractures, but reports about their implications for mid-term clinical outcomes is sparse. METHODS A single-centre retrospective study was conducted at a university teaching hospital investigating paediatric patients who underwent operative management of a distal humerus fracture between 2014 and 2018. Patient demographics, fracture classification, pre-, peri- and postoperative neurovascular complications were investigated. Mid-term follow up clinical examination and functional scoring using QuickDASH, the Broberg and Morrey Score (BMS), the Mayo Elbow Performance Score (MEPS) and the Numeric Rating Scale were performed. RESULTS A total of 84 patients were identified, of which 34 met the inclusion criteria and were available for follow-up clinical examination. The average time to follow-up was 150 weeks (1049.44 days ± 448.54). Ten primary traumatic neurovascular complications were identified, the majority of which involved the median nerve. Primary traumatic dissection of the brachial artery was recorded in three patients. Secondary iatrogenic nerve injury was documented in five patients after previously normal clinical examination. At follow-up, the average QuickDASH score was 3.0 ± 4.3, BMS was 98.6 ± 3.4 and MEPS was 97.1 ± 3.3 points. CONCLUSIONS The mid-term clinical outcome following surgical management of distal humerus fractures is excellent. There is, however, a considerable frequency of both primary and secondary neurovascular complications, which must be considered when opting to treat these injuries surgically.
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Affiliation(s)
- Alexander Gutwerk
- Department of Orthopedic, Trauma, Hand and Reconstructive Surgery, DIAKO Clinic, 24939 Flensburg, Germany
| | - Peter Behrendt
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios St. Georg, 20099 Hamburg, Germany
- Department of Anatomy, Christian-Albrechts-University, 24118 Kiel, Germany
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Svenja Vetter
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Leif Menzdorf
- Department of Orthopedic, Trauma, Hand and Reconstructive Surgery, DIAKO Clinic, 24939 Flensburg, Germany
| | - Edward Oates
- Department of Orthopedic, Trauma, Hand and Reconstructive Surgery, DIAKO Clinic, 24939 Flensburg, Germany
| | - Sebastian Jazra
- Department of Orthopedic, Trauma, Hand and Reconstructive Surgery, DIAKO Clinic, 24939 Flensburg, Germany
| | - Sebastian Lippross
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Tim Klüter
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Andreas Seekamp
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Matthias Weuster
- Department of Orthopedic, Trauma, Hand and Reconstructive Surgery, DIAKO Clinic, 24939 Flensburg, Germany
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
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Supracondylar Fractures of the Humerus: Association of Neurovascular Lesions with Degree of Fracture Displacement in Children—A Retrospective Study. CHILDREN 2022; 9:children9030308. [PMID: 35327679 PMCID: PMC8946881 DOI: 10.3390/children9030308] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022]
Abstract
Supracondylar humerus fractures (ScHF) account for 60% of fractures of the elbow region in children. We assessed the relationship between neurovascular complications and the degree of fracture displacement as rated on the basis of modified Gartland classification. Moreover, we aimed to evaluate predisposing factors, e.g., age and gender, and outcomes of neurovascular complications in ScHF. Between 2004 and 2019, we treated 329 patients with ScHF at the Department of Traumatology and Orthopedics of the Upper Silesian Child Centre, Katowice, Poland. Mean age of patients (189 boys and 140 girls) was 7.2 years (Confidence interval: 6.89, 7.45). Undisplaced fractures were treated conservatively with a cast. Displaced fractures were managed by closed reduction and percutaneous Kirschner wire fixation using two pins inserted laterally. We retrospectively assessed the number of neurovascular lesions at baseline and recorded any iatrogenic injury resulting from the surgical intervention. Acute neurovascular lesions occurred in 44 of 329 ScHF patients (13.4%). The incidence of accompanying neurovascular injuries was positively associated with the severity of fracture displacement characterized by Gartland score. Vascular injuries occurred mainly in Gartland type IV ScHF, while nerve lesions occurred in both Gartland type III and IV ScHF. We noted a significantly higher mean Gartland score and mean age at injury in the group of children suffering from neurovascular injuries when compared to those in the group without such injuries (p = 0.045 and p = 0.04, respectively). We observed no secondary nerve lesions after surgical treatment. For the treatment of ScHF in children, we recommend closed reduction and stabilization of displaced fractures with K-wires inserted percutaneously from the lateral aspect of the upper arm. We advocate vessel exploration in case of absent distal pulses after closed reduction but do not consider primary nerve exploration necessary, unless a complete primary sensomotoric nerve lesion is present.
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Yang L, Yang P, Li L, Tang X. The outcome of loose bone fragments in pediatric supracondylar humerus fractures: a retrospective study. J Pediatr Orthop B 2022; 31:12-17. [PMID: 33230053 PMCID: PMC8614548 DOI: 10.1097/bpb.0000000000000837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/07/2020] [Indexed: 02/05/2023]
Abstract
We evaluated the clinical and imaging outcomes of loose bone fragments in children with supracondylar humerus fractures after closed reduction with percutaneous pin (CRPP) fixation. A retrospective review was conducted on 12 children with fragments on imaging after closed reduction of displaced humeral supracondylar fractures (Gartland III). Primary radiographic assessment included fragment outcome, postoperative Baumann angle, carrying angle and loss of reduction. Clinical outcome included the elbow range of motion (ROM), Flynn grade and other complications. Between January 2015 and January 2018, 460 children (2-14 years old) with supracondylar humerus fractures were treated at our center, including 12 (2.6%) with loose bone fragments on postoperative X-ray. Union or absorption of fragments was noted in all 12 patients at 1 year postoperatively, with good radiographic and clinical outcomes. The mean Baumann angle was 15.5° ± 4.3° and the mean carrying angle was 11.2° ± 2.8°. All patients had a normal elbow ROM. Ten patients achieved an excellent and two a good result according to the Flynn criteria. Good results were achieved after CRPP fixation in 12 children with supracondylar humerus fractures and loose bone fragments. The fragments were mainly absorbed or achieved union to the humerus within 1 year.
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Affiliation(s)
- Lei Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guo Xue Xiang, Chengdu, Sichuan, People’s Republic of China
| | - Panyi Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guo Xue Xiang, Chengdu, Sichuan, People’s Republic of China
| | - Lang Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guo Xue Xiang, Chengdu, Sichuan, People’s Republic of China
| | - Xueyang Tang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guo Xue Xiang, Chengdu, Sichuan, People’s Republic of China
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Okkaoglu MC, Ozdemir FE, Ozdemir E, Karaduman M, Ates A, Altay M. Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours? J Orthop Surg Res 2021; 16:484. [PMID: 34376234 PMCID: PMC8353804 DOI: 10.1186/s13018-021-02638-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022] Open
Abstract
Background We aimed to determine the ideal surgical timing in the first 24 hours after admission to the hospital of pediatric supracondylar humerus fractures (SHF) that do not require emergent intervention. Materials and Methods Patients who underwent surgery in our institution between January 2011 and January 2019 due to pediatric Gartland type 3 SHFs were evaluated retrospectively. Open fractures, fractures associated with vascular injury and compartment syndrome, flexion type fractures were excluded. A total of 150 Gartland type 3 were included. The effect of early (<12 hours) or late (>12 hours) surgical interventions, daytime or night-time surgeries, working or non-working hour surgeries on operative parameters (operative duration and open reduction rate, reduction quality on postoperative early radiographs) were evaluated in pediatric SHFs. Results Early (<12 hours) or late (>12 hours), daytime or nighttime, working or non-working hour surgeries were found to be similar in Gartland type 3 patients regarding early postoperative reduction quality, duration of surgery, open reduction rate (p>0.05). Mean times passed from first admission to hospital until surgery were longer in working hour, late (>12 hours) and daytime surgery groups than non-working hour, early (<12 hours) and night-time surgery groups (p<0.001). Conclusion Although delaying the operation to the working hours seems to prolong the time until surgery in pediatric Gartland type 3 SHF patients who do not require emergent intervention such as open fractures, neurovascular impairment and compartment syndrome, there may not be a time interval that makes a difference for the patients if surgery is performed within the first 24 hours, thus the surgery could be scheduled according to the surgeons’ preference. Level of Evidence: Level 3, Retrospective cohort study
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Affiliation(s)
- Mustafa Caner Okkaoglu
- Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Kecioren Training and Research Hospital, Pınarbaşı District, Sanatoryum Street, D:25, 06280, Keçiören, Ankara, Turkey.
| | - Fırat Emin Ozdemir
- Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Kecioren Training and Research Hospital, Pınarbaşı District, Sanatoryum Street, D:25, 06280, Keçiören, Ankara, Turkey
| | - Erdi Ozdemir
- Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Kecioren Training and Research Hospital, Pınarbaşı District, Sanatoryum Street, D:25, 06280, Keçiören, Ankara, Turkey
| | - Mert Karaduman
- Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Kecioren Training and Research Hospital, Pınarbaşı District, Sanatoryum Street, D:25, 06280, Keçiören, Ankara, Turkey
| | - Ahmet Ates
- Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Kecioren Training and Research Hospital, Pınarbaşı District, Sanatoryum Street, D:25, 06280, Keçiören, Ankara, Turkey
| | - Murat Altay
- Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Kecioren Training and Research Hospital, Pınarbaşı District, Sanatoryum Street, D:25, 06280, Keçiören, Ankara, Turkey
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Slongo T. [Technique and biomechanics of Kirschner wire osteosynthesis in children]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 32:509-529. [PMID: 33237395 PMCID: PMC7688098 DOI: 10.1007/s00064-020-00684-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Safe and stable fixation of metaphyseal and epiphyseal fractures by Kirschner (K-)wire osteosynthesis. Use of various K‑wire configurations depending on the fracture morphology. INDICATIONS In accordance with the AO Pediatric Comprehensive Classification of Long-Bone Fractures (PCCF), all Salter-Harris (SH) and metaphyseal fractures as well as fractures of the foot and hand independent of the reduction technique, closed or open, provided that adaptation osteosynthesis allows sufficient stability. Fixation/immobilization in a plaster cast is mandatory after K‑wire osteosynthesis. CONTRAINDICATIONS All diaphyseal fractures, if a K-wire is not used as an intramedullary nail. Fractures that can not be correctly reduced or are nonreducible fractures. SURGICAL TECHNIQUE After closed or open, as anatomical reduction as possible, one, two, occasionally three K‑wires per fragment are inserted under fluoroscopic control. Care must be taken that the K‑wires optimally capture the fragment to be fixed as well as the main fragment (metaphysis). It must therefore be possible to make a strictly lateral and correct anteroposterior x‑ray by image intensifier. It is important that the C‑arm can be positioned at the appropriate level. Rotating the limb should be minimized, as prior to fixation the previously reduced fragments may shift again, resulting in poor K‑wire fixation. Depending on the morphology of the fracture, size of the fragments and location of the fracture (humerus, forearm, femur or tibia, hand or foot), the K‑wiring technique must be adapted, e.g., mono-laterally crossed, mono-laterally divergent, in an ascending or descending direction, or the most commonly used ascending crossed technique. In most cases, the K‑wires protrude through the sin and the exposed ends are bent. This allows removal without renewed anesthesia in the outpatient setting. K‑wire osteosynthesis is neither a compression osteosynthesis (OS) nor a neutralization OS, but is always an adaptation and fixation of the fragments. Therefore, K‑wire OS always needs additional immobilization using a plaster or prefabricated splint. POSTOPERATIVE MANAGEMENT Immobilization in plaster cast for 4-5 weeks, depending on the age; care must be taken to avoid interference between the cast and the skin/K-wires. RESULTS With technically and optimally performed fixation and correct indication for K‑wire OS, as well as adequate posttreatment, very good to good results are achieved.
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Affiliation(s)
- Theddy Slongo
- Traumatologie des Bewegungsapparates, Kinderorthopädie, Universitätsklinik für Kinderchirurgie, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz.
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Pavone V, Vescio A, Riccioli M, Culmone A, Cosentino P, Caponnetto M, Dimartino S, Testa G. Is Supine Position Superior to Prone Position in the Surgical Pinning of Supracondylar Humerus Fracture in Children? J Funct Morphol Kinesiol 2020; 5:57. [PMID: 33467272 PMCID: PMC7739299 DOI: 10.3390/jfmk5030057] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Supracondylar humerus fracture (SCHF) is a frequent injury in pediatric ages. Closed reduction and percutaneous pin fixation is a common treatment of displaced SCHF. Surgery is usually performed in the supine position; otherwise the prone position allows an easier fracture reduction and a safe placement of pins. The aim of study is to compare the clinical and radiographic results of the treatment of displaced SCHF, comparing two different intra-operative positionings. METHODS 59 SCHF affected children were retrospectively divided into supine (Group 1; n = 34) and prone (Group 2; n = 25), according to intraoperative position. All treated subjects were clinically evaluated according to Flynn's criteria and Mayo Elbow Performance Score, and radiographically, including the measurement of the Baumann angle. RESULTS Clinically, Group 1, according Flynn's criteria, had excellent cosmetic outcome in 32 subjects (94.1%). Mean MAYO Score was 96.0 ± 3.8. Group 2, according Flynn's criteria, had excellent cosmetic outcomes in 23 subjects (92.0%). Mean MAYO Score was 97.8 ± 3.3. Radiographically, mean difference of Baumann's angle between the injured limb and the normal limb was 5.5° ± 1.0° in Group 1 and 5.1° ± 1.1° in Group 2. CONCLUSION Both supine and prone positioning achieved a satisfying outcome with similar results in joint function recovery and complications.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.C.); (P.C.); (M.C.); (S.D.); (G.T.)
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.C.); (P.C.); (M.C.); (S.D.); (G.T.)
| | - Maria Riccioli
- Dipartimento Area Chirurgica, U.O.C. di Ortopedia e Traumatologia, Ospedale Umberto I di Siracusa, 96100 Siracusa, Italy;
| | - Annalisa Culmone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.C.); (P.C.); (M.C.); (S.D.); (G.T.)
| | - Pierluigi Cosentino
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.C.); (P.C.); (M.C.); (S.D.); (G.T.)
| | - Marco Caponnetto
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.C.); (P.C.); (M.C.); (S.D.); (G.T.)
| | - Sara Dimartino
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.C.); (P.C.); (M.C.); (S.D.); (G.T.)
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.C.); (P.C.); (M.C.); (S.D.); (G.T.)
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Liebs TR, Burgard M, Kaiser N, Slongo T, Berger S, Ryser B, Ziebarth K. Health-related quality of life after paediatric supracondylar humeral fractures. Bone Joint J 2020; 102-B:755-765. [PMID: 32475234 DOI: 10.1302/0301-620x.102b6.bjj-2019-1391.r2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS We aimed to evaluate the health-related quality of life (HRQoL) in children with supracondylar humeral fractures (SCHFs), who were treated following the recommendations of the Paediatric Comprehensive AO Classification, and to assess if HRQoL was associated with AO fracture classification, or fixation with a lateral external fixator compared with closed reduction and percutaneous pinning (CRPP). METHODS We were able to follow-up on 775 patients (395 girls, 380 boys) who sustained a SCHF from 2004 to 2017. Patients completed questionnaires including the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH; primary outcome), and the Pediatric Quality of Life Inventory (PedsQL). RESULTS An AO type I SCHF was most frequent (327 children; type II: 143; type III: 150; type IV: 155 children). All children with type I fractures were treated nonoperatively. Two children with a type II fracture, 136 with a type III fracture, and 141 children with a type IV fracture underwent CRPP. In the remaining 27 children with type III or IV fractures, a lateral external fixator was necessary for closed reduction. There were no open reductions. After a mean follow-up of 6.3 years (SD 3.7), patients with a type I fracture had a mean QuickDASH of 2.0 (SD 5.2), at a scale of 0 to 100, with lower values representing better HRQoL (type II: 2.8 (SD 10.7); type III: 3.3 (SD 8.0); type IV: 1.8 (SD 4.6)). The mean function score of the PedsQL ranged from 97.4 (SD 8.0) for type I to 96.1 (SD 9.1) for type III fractures, at a scale of 0 to 100, with higher values representing better HRQoL. CONCLUSION In this cohort of 775 patients in whom nonoperative treatment was chosen for AO type I and II fractures and CRPP or a lateral external fixator was used in AO type III and IV fractures, there was equally excellent mid- and long-term HRQoL when assessed by the QuickDASH and PedsQL. These results indicate that the treatment protocol followed in this study is unambiguous, avoids open reductions, and is associated with excellent treatment outcomes. Cite this article: Bone Joint J 2020;102-B(6):755-765.
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Affiliation(s)
- Thoralf R Liebs
- Department of Paediatric Orthopaedics and Traumatology, Clinic for Paediatric Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie Burgard
- Department of Paediatric Orthopaedics and Traumatology, Clinic for Paediatric Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nadine Kaiser
- Department of Paediatric Orthopaedics and Traumatology, Clinic for Paediatric Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Teddy Slongo
- Department of Paediatric Orthopaedics and Traumatology, Clinic for Paediatric Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Steffen Berger
- Department of Paediatric Orthopaedics and Traumatology, Clinic for Paediatric Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Basil Ryser
- Department of Paediatric Orthopaedics and Traumatology, Clinic for Paediatric Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kai Ziebarth
- Department of Paediatric Orthopaedics and Traumatology, Clinic for Paediatric Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
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Suganuma S, Tada K, Yasutake H, Horii T, Takata M, Shimanuki K, Tsuji D, Takagawa S, Asano Y, Tsuchiya H. Timing of Surgery for Pediatric Supracondylar Humerus Fractures and Early Postoperative Results. J Hand Surg Asian Pac Vol 2020; 25:226-231. [PMID: 32312197 DOI: 10.1142/s2424835520500277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Pediatric supracondylar humerus fracture (PSHF) is one of the most common fractures of the elbow seen among boys aged between 5 and 7 years. The timing of surgical treatment for this type of fracture is still controversial. Thus, we aimed to investigate whether the timing of surgery for PSHFs affects the incidence of early postoperative complications and reduction of PSHFs. Methods: We retrospectively reviewed the medical records of PSHF patients who underwent surgery at our hospital between January 2007 and March 2019. We classified patients who underwent surgery within 12 h and more than 12 h after the fracture as the early and delayed groups, respectively. The outcome measures compared between the two groups were the incidence of postoperative early complications such as neurological deficits, including iatrogenic ulnar nerve injury, vascular compromise, compartment syndrome, K-wire migration, and unplanned returns to the operating room. We also examined surgical time, reduction procedure, and perioperative radiographic parameters. Results: There was no significant difference in the incidence of early complications between the early and delayed groups for either modified Gartland type II or type III fractures. There was also no significant difference in surgical time, reduction procedure, or perioperative radiographic parameters between the two groups. Conclusions: Delayed surgery was not associated with an increased rate of postoperative early complications in either type II or type III fractures. The timing of surgery does not affect the difficulty or quality of reduction.
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Affiliation(s)
- Seigo Suganuma
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kaoru Tada
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Hidetoshi Yasutake
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Takeshi Horii
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Munetomo Takata
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Keito Shimanuki
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Daiyu Tsuji
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Shingo Takagawa
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Yohei Asano
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan
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Farrow L, Ablett AD, Mills L, Barker S. Early versus delayed surgery for paediatric supracondylar humeral fractures in the absence of vascular compromise: a systematic review and meta-analysis. Bone Joint J 2018; 100-B:1535-1541. [PMID: 30499316 DOI: 10.1302/0301-620x.100b12.bjj-2018-0982.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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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Affiliation(s)
- L Farrow
- Trauma & Orthopaedic Surgery, Royal Aberdeen Children's Hospital, Aberdeen, UK; Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - A D Ablett
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - L Mills
- Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - S Barker
- Royal Aberdeen Children's Hospital, Aberdeen, UK
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Tomori Y, Nanno M, Takai S. Clinical results of closed versus mini-open reduction with percutaneous pinning for supracondylar fractures of the humerus in children: A retrospective case-control study. Medicine (Baltimore) 2018; 97:e13162. [PMID: 30407346 PMCID: PMC6250557 DOI: 10.1097/md.0000000000013162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To compare the clinical outcomes of 2 procedures, closed or mini-open reduction with percutaneous pinning (ORPP), for the treatment of supracondylar fractures of the humerus in children.Patients aged less than 15 years who had undergone surgery for supracondylar fracture of the humerus between 2004 and 2013 were identified. The case records and radiographs from 34 patients were reviewed. Twenty-one patients had undergone closed reduction followed by percutaneous pinning (CRPP), while 13 had undergone mini-open reduction through the anterior approach with percutaneous pinning (mini-ORPP). The average age of the patients at the time of surgery was 5.4 (1-13) years in the CRPP group and 5.4 (2-9) years in the mini-ORPP group. The average age of the patients at the time of surgery was 5.4 (1-13) years in the CRPP group and 5.4 (2-9) years in the mini-ORPP group. Based on the Gartland classification system, the CRPP group included 12 type 2 and 9 type 3 fractures, while the mini-ORPP group included 4 type 2 and 9 type 3 fractures. The average postoperative follow-up duration was 8 (3-21) months in the CRPP group and 10 (3-10) months in the mini-ORPP group. The investigated parameters were postoperative complications, radiographic evaluation, and clinical evaluation, including range of motion (ROM) and Flynn's criteria. To evaluate the deformity of the humerus, Baumann's angle and the carrying angle (CA) were calculated on anteroposterior radiographs.Although no patient showed loss of reduction, deep infection, or neurovascular complications, 1 patient in the CRPP group had a cubitus varus deformity. The average CA loss in the injured elbow compared with the CA of the contralateral side was significantly larger in the CRPP group than the mini-ORPP group. In accordance with Flynn's criteria, the results in the CRPP group were excellent in 12 patients, good in 8, and poor in 1; the results in the mini-ORPP group were excellent in 12, and good in 1.To eliminate the possibility of postoperative cubitus varus deformity, the mini-ORPP is the optimal procedure for supracondylar fracture of the humerus in children.
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Pediatric supracondylar humerus fractures: is surgeon experience a surrogate for the need of open reduction? J Pediatr Orthop B 2018; 27:103-107. [PMID: 28723700 DOI: 10.1097/bpb.0000000000000487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although there are many factors that are likely to influence the need for open reduction and percutaneous pinning (ORPF) in the treatment of pediatric supracondylar humerus fractures (SCHFs), the role of surgeon's experience (as represented by the total number of surgically treated SCHFs) on the need for ORPF has seldom been investigated. We reviewed the data on all completely displaced, pediatric SCHFs that were treated surgically by a single, fellowship-trained, pediatric orthopedic surgeon over the first 10 years of the surgeon's clinical practice. The incidence of ORPF was calculated as the percentage of open reductions among surgically treated, completely displaced, consecutive SCHFs at any given time during the 10-year period. From September 2005 to August 2015, a total of 212 completely displaced SCHFs were treated surgically at our institution by a single surgeon. When analyzing the incidence of ORPFs among surgically treated, completely displaced SCHFs at any given time, a bimodal curve was found: there was an increasing slope over the first 30 surgically treated SCHFs, with a progressive decreasing slope afterward. The incidence of ORPF within the first 10, 20, and 30 surgically treated, completely displaced SCHFs was 10.0, 30.0, and 26.7%, respectively, decreasing to 16.0, 9.0, 6.7, and 5.0% within the first 50, 100, 150, and 200 surgeries, respectively. The incidence of ORPF was almost 17-fold higher within the first 30 surgically treated, completely displaced SCHFs (17%), when compared with the following 182 (1.1%) cases (P<0.00001). Although it is likely that many factors influence the need for ORPF in the treatment of completely displaced SCHFs, surgeon's experience appears to play a significant role. Strategies aimed to accelerate the learning curve in the treatment of pediatric SCHFs should be undertaken.
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Comparison of daytime and after-hours surgical treatment of supracondylar humeral fractures in children. J Pediatr Orthop B 2017; 26:400-404. [PMID: 27782937 DOI: 10.1097/bpb.0000000000000403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Reports on different types of surgical procedures show that night-time surgeries are often associated with a high number of complications than daytime surgeries. However, there are no data, and hence evidence that relate the outcome of supracondylar humeral fractures in children to the time of the day when the respective surgical procedure is implemented. In this study, we analyze the clinical and radiological outcomes of pediatric supracondylar humeral fractures surgically treated during daytime and night-time hours. In total, 91 patients with Gartland type-3 fractures were included; 47 patients treated between 0800 and 1700 h were defined as the daytime group and 44 patients treated between 1701 and 0759 h were defined as the after-hours group. Age, sex, affected side, fracture type, and day and time of operation were recorded. Any preoperative neurovascular injuries, open fractures, or ipsilateral fractures were noted. The surgical method, use of a medial pin or pins, operation time, any postoperative neurovascular complications, extent of successful reduction, fixation rate, any resultant deformity, and functional loss rate were evaluated. The two groups did not differ significantly in terms of operation time, open reduction rate, rate of poor reduction, extent of poor functional outcomes, or induction of deformity (P>0.05). The poor fixation rate was significantly greater in the after-hours group than in the daytime group (P<0.05). No significant between-group differences were evident in age, sex, affected side, or length of postoperative follow-up (all P-values>0.05). After-hours treatment of displaced supracondylar humeral fractures in children is associated with a higher poor fixation rate compared with daytime procedures. LEVEL OF EVIDENCE therapeutic study (retrospective comparative study), Level III.
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Analysis of Early Neurovascular Complications of Pediatric Supracondylar Humerus Fractures: A Long-Term Observation. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2803790. [PMID: 28367440 PMCID: PMC5359433 DOI: 10.1155/2017/2803790] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/14/2017] [Indexed: 12/18/2022]
Abstract
Purpose. Analysis of early vascular and nerve complications of supracondylar humerus fractures in children. Material and Methods. 220 children hospitalized in the Pediatric Trauma-Orthopedic Department in the years 2004–2014. The group consisted of 143 males and 77 females. Results. Acute neurovascular complications occurred in 16.81% of patients with displaced supracondylar fracture (37 children). Nerve damage was found in 10% of patients with displaced fracture (22 children). The most injured nerve was median nerve; this complication occurred in 15 patients (68.18%). The total nerve function returned after average of 122 days (0–220 days after surgery). Symptoms of vascular injury occurred in 7.7% children with displaced fracture (17 children). Conclusions. (1) In children with supracondylar fracture the most often injured nerve is median nerve. (2) The incidence of vascular and nerve complications positively correlates with the progression of fracture according to Gartland classification.
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Leiblein M, Lustenberger T, Schulz AK, Schmitz-Rixen T, Marzi I. Neurovascular complications after supracondylar humerus fractures in children. Trauma Case Rep 2017; 8:16-19. [PMID: 29644308 PMCID: PMC5883211 DOI: 10.1016/j.tcr.2017.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 01/31/2023] Open
Abstract
Background Supracondylar fractures of the humerus are a common injury in pediatric traumatology. The most common operative therapy is closed reduction and percutaneous pinning using K-wires. Common complications associated with this entity are neurovascular lesions, especially of the brachial artery and the median nerve. Methods We report two cases of patients treated in our trauma-center with supracondylar fracture of the humerus (AO IV°) and neurovascular complications. Results Both patients underwent open revision and recovered completely in their further course. Conclusion We recommend detailed neurovascular examination initially and after reposition of the fracture. The threshold for open reduction in cases of irreducible fractures should be low. In the presence of neurovascular impairment an open revision is mandatory, even months after the initial Trauma.Level of evidence: Level V (case report).
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Affiliation(s)
- Maximilian Leiblein
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Thomas Lustenberger
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Anne-Kathrin Schulz
- Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt/M., Theodor-Stern-Kai 7, 60590 Frankfurt/M, Germany
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, Hospital of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Zhong W, Wang XW. Clinical study of emergency treatment and selective closed reduction for the treatment of supracondylar humerus fracture in children. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Pavone V, Riccioli M, Testa G, Lucenti L, De Cristo C, Condorelli G, Avondo S, Sessa G. Surgical Treatment of Displaced Supracondylar Pediatric Humerus Fractures: Comparison of Two Pinning Techniques. J Funct Morphol Kinesiol 2016; 1:39-47. [DOI: 10.3390/jfmk1010039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2025] Open
Abstract
The aim of this study is to report the results of the treatment of displaced supracondylar humerus fractures comparing two different techniques, crossed and lateral pins. We retrospectively reviewed 35 children hospitalized between May 2005 and December 2012. Patients were treated with two different pin configurations, crossed (Group 1) and lateral (Group 2). After surgery, clinical and radiographic evaluation was performed. Postoperatively, the clinical assessment showed recovery of joint function of the elbow. Radiographically, Group 1 showed a difference in the Baumann angle between the value of the injured limb and the normal angle of 5.3° ± 2.12°; in Group 2 the difference was 4.9° ± 2.82°. Complications: group 1, two cases of short paresthesia, one case of slight varus, mild asymmetry, and deficit to extension of the humerus and group 2, two cases of local infection and one of a slight hyperextension were reported. Both groups achieved a satisfying outcome with similar results in joint function recovery and complications.
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Affiliation(s)
- Vito Pavone
- Department of Orthopedics, University of Catania, Via Plebiscito, 628, 95124 Catania, Italy
| | - Maria Riccioli
- Department of Orthopedics, University of Catania, Via Plebiscito, 628, 95124 Catania, Italy
| | - Gianluca Testa
- Department of Orthopedics, University of Catania, Via Plebiscito, 628, 95124 Catania, Italy
| | - Ludovico Lucenti
- Department of Orthopedics, University of Catania, Via Plebiscito, 628, 95124 Catania, Italy
| | - Claudia De Cristo
- Department of Orthopedics, University of Catania, Via Plebiscito, 628, 95124 Catania, Italy
| | - Giuseppe Condorelli
- Department of Orthopedics, University of Catania, Via Plebiscito, 628, 95124 Catania, Italy
| | - Sergio Avondo
- Department of Orthopedics, University of Catania, Via Plebiscito, 628, 95124 Catania, Italy
| | - Giuseppe Sessa
- Department of Orthopedics, University of Catania, Via Plebiscito, 628, 95124 Catania, Italy
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