Displaced Type II Extension Supracondylar Humerus Fractures

Parikh, Shital N.; Wall, Eric J.; Foad, Susan L.; Wiersema, Brent; Nolte, Barbara

doi:10.1097/00004694-200407000-00007

Cited by 18 publications

(25 citation statements)

References 8 publications

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“…We found 28 studies examining outcome data of closed reduction and casting for displaced supracondylar fractures. 17–43 This included any method of immobilisation whereby plaster of Paris was applied to the injured arm, set under any degree of flexion. Closed reduction was performed and, where specified, manipulation of the displaced injury was performed under general anaesthetic, local block or sedation.…”

Section: Resultsmentioning

confidence: 99%

Conservative management of displaced paediatric supracondylar fractures: a systematic review

et al. 2018

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In low-income countries, where surgical expertise and resources are limited, displaced supracondylar fractures of the distal humerus are routinely managed with traction or closed reduction and casting. This is in contrast to high-income nations, where percutaneous K-wire fixation forms the mainstay of treatment. The aim of our study is to present the published evidence regarding the outcome of conservatively managed displaced supracondylar fractures in children. A systematic review of the literature was performed identifying 46 studies evaluating the outcome of displaced supracondylar fractures managed non-operatively. Our results show management by traction is equivalent to percutaneous pinning, whereas outcomes following closed reduction and casting were inconsistent. Traction therefore remains a viable option in low- and middle-income countries (LMICs). However, at present there are few data from LMICs, limiting the transferability of our conclusions.

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Section: Resultsmentioning

confidence: 99%

Conservative management of displaced paediatric supracondylar fractures: a systematic review

et al. 2018

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“…The optimal treatment for Gartland type 2 fractures has been historically widely debated. In 1991 Ippolito and Perugia 40 reported good results with trans-olecranic traction and casting; more recently Parikh et al 41 and Spencer et al 42 showed how closed reduction and casting is a safe and effective treatment, as well as other authors 13 stated that pinning all type 2 fractures would result in 77% of unnecessary surgery.…”

Section: Discussionmentioning

confidence: 97%

Conservative versus surgical treatment of Gartland type 2 supracondylar humeral fractures: What can help us choosing?

Iorio

Crostelli

Mazza

et al. 2019

Journal of Orthopaedics

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Background: Pediatric supracondylar humeral fractures (PSHF) are most common elbow fractures among children and adolescents. While there is substantial agreement on treating type 1 and type 3 fractures (conservatively and surgically, respectively), the debate on optimal treatment of Gartland type 2 fractures is still open. We wanted to review our cases, analyzing outcomes and seeking for parameters that could help surgeons treating these injuries. Methods: We retrospectively reviewed 41 patients treated with reduction and casting (group A) and matched to 38 patients treated with closed reduction and percutaneous pining (CRPP, group B) for Gartland type 2 fractures between 2009 and 2013. At a mean follow-up of more than 6 years patients were analyzed by an accurate clinical exam and evaluation scales. Radiographic parameters at time of cast or pins removal were studied too. Results: There were no statistically significant differences in clinical exam and evaluation scales between groups. Two patients in group A developed a cubitus varus deformity and one patient in group B had a superficial pintract infection. Baumann angle (BA) was out of normal range in two cases of conservative group and anterior humeral line (AHL) bisected capitellum in 42.1% of patients in group A and 73.2% in group B (p < .05). Conclusion: It is reasonable to expect satisfactory outcomes both after conservative and surgical treatment of type 2 fractures, if cornerstones of both treatments are applied. Parameters that should be focused are probably two: complications (2 cases of cubitus varus in group A versus one superificial pin-tract infections in group B) and the better trend in surgical group in regards to loss of flexion and hyperextension of the affected elbow, likely related to the other notable datum, that is the percentage of cases in which AHL bisects capitellum. We think that, in absence of vascolonervous lesions and important swelling, BA and AHL are the most important parameters that can help us choosing the optimal treatment, as clarified in the algorithm we developed. Level of evidence: Level IIIretrospective comparative study.

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“…One of the four groups who treat children with supracondylar humerus fractures within our city prefers to treat the majority of extension type II fractures with closed reduction and cast immobilization in the emergency department and then close follow-up to determine the need for surgery, while the other practices typically favor planned delayed closed reduction and percutaneous pinning. Operative and nonoperative treatment are both supported in the literature [ 4 , 5 , 7 – 9 , 13 , 15 , 30 ], although operative management is advocated by the AAOS [ 3 ]. While some may argue that surgical treatment is not required to manage these fractures due to satisfactory long-term results [ 31 ], the need for close follow-up is still important to avoid loss of reduction and malunion in either treatment method, as long-term angular deformity can result in symptomatic cubitus varus or loss of flexion [ 2 , 27 – 29 , 32 – 38 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of insurance status on ability to return for outpatient management of pediatric supracondylar humerus fractures

Fletcher

Sirmon

Mansour

et al. 2016

Journal of Children's Orthopaedics

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PurposeOutcomes are excellent following surgical management of displaced supracondylar humerus fractures. Short delays until surgical fixation have been shown to be equivalent to immediate fixation with regards to complications. We hypothesized that insurance coverage may impact access to care and the patient’s ability to return to the operating room for outpatient surgery.MethodsA retrospective review of supracondylar humerus fractures treated at a large urban pediatric hospital from 2008 to 2012 was performed. Fractures were classified by the modified Gartland classification and baseline demographics were collected. Time from discharge to office visits and subsequent surgical fixation was calculated for all type II fractures discharged from the emergency department. Insurance status and primary carrier were collected for all patients.Results2584 supracondylar humerus fractures were reviewed, of which 584 were type II fractures. Of the 577 type II fractures with complete records, 383 patients (61 %) were admitted for surgery and the remaining 194 were discharged with plans for outpatient follow-up. There was no difference in insurance status between patients admitted for immediate surgery. Of the 194 patients who were discharged with type 2 fractures after gentle reduction, 59 patients (30.4 %) ultimately underwent surgical fixation. Of these, 42 patients were privately insured (58.3 % of patients with private insurance), 16 had governmental insurance (15.1 %), and 1 was uninsured (6.3 %). Patients with private insurance were 2.46 times more likely to have surgery than patients with public or no insurance (p = 0.005). Of the 135 patients who did not eventually have surgery, 92 (68.1 %) were seen in the clinic. Patients with private insurance were 2.78 times more likely to be seen back in the clinic when compared to publicly insured or uninsured patients (p = 0.0152).ConclusionsDespite an equivalent number of privately insured and publicly insured patients undergoing immediate surgery for type II fractures, those with public or no insurance who were discharged were 2.46 times less likely to obtain outpatient surgery when compared to privately insured patients. Patient insurance status and the ability to follow up in a timely manner should be assessed at the time of initial evaluation in the emergency department.Level of evidence Level 3

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Displaced Type II Extension Supracondylar Humerus Fractures

Cited by 18 publications

References 8 publications

Conservative management of displaced paediatric supracondylar fractures: a systematic review

Conservative management of displaced paediatric supracondylar fractures: a systematic review

Conservative versus surgical treatment of Gartland type 2 supracondylar humeral fractures: What can help us choosing?

Impact of insurance status on ability to return for outpatient management of pediatric supracondylar humerus fractures

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