Learning Curve of Closed Reduction and Internal Fixation for Supracondylar Fractures of the Humerus in Children

Abstract

BackgroundThis study aimed to identify the threshold for success in supracondylar humeral fracture surgery by describing the learning curve for beginners and exploring the relationship between the learning curve and the prognosis of supracondylar fractures of the humerus.MethodsSurgical information was collected of the first 100 humeral fractures treated by four pediatric orthopedic surgeons. The relationship between operation time, wire placement success rate, and surgical experience was determined using the restricted cubic strip (RCS). The inflection point in the curve and other risk factors that may affect fracture prognosis were collected and subjected to multiple logistic regression to clarify the relationship between the learning curve and prognosis of supracondylar fractures of the humerus. After the training, the four fresh surgeons were interviewed in the form of questionnaires to get feedback from the trainees.ResultsA total of 400 supracondylar fractures of the humerus from four pediatric orthopedists were included in the study. On an RCS analysis, 65 surgical experiences were the inflection point of the learning curve. Before and after these 65 surgical experiences, there were significant differences in the patients' anatomical reduction (186 vs. 122, P < 0.001), conversion to incision (33 vs. 6, P = 0.008), and supervising physician guidance (28 vs. 2, P < 0.001). In the multiple logistic regression analysis, functional recovery after supracondylar fractures of the humerus was significantly associated with surgical experience, intraoperative conversion to incision, and post-operative infection. Four surgeons and a supervisor were interviewed. They believed that self-confidence establishment requires the experience accumulation of about 30 operations. The most critical surgical technique is the reduction of fractures.ConclusionsAlthough the accumulated experience of 30 operations can establish the self-confidence of trainers, fresh surgeons must accumulate experience with 65 operations to master closed reduction and internal fixation for supracondylar fractures. Surgical experience significantly impacts the post-operative recovery of patients with fractures.Level of EvidenceLevel III.

The Effect of Fracture Patterns, Pinning Configuration, Surgeon Experience and Subspecialty on Short-Term Radiological Outcomes of Pediatric Supracondylar Humeral Fractures Treated in the Prone Position: A Case-Series

“…These findings underscore the significance of a surgeon's experience, which directly influences outcomes, considering the notable learning curve associated with this procedure. In contrast, a recent study found no differences in adverse events at 30 days, reoperations or readmissions when comparing the performance of young and senior surgeons [12].…”

“…The authors hypothesized that the inability to successfully complete the reduction or experience of multiple unsuccessful attempts at implant placement did not affect the patient's prognosis. However, the experience accumulated from 65 operations is not the time necessary to learn the operation, but the time needed to achieve the stability of individual surgical techniques [12]. In the present series, the novice operators were supported by an experienced surgeon defined as a specialist who performed more than 15 CRPP and/or has more than 10 years of surgical experience.…”

“…Similarly, the surgeon's experience did not affect the postoperative results. In a recent study, Qian et al [12] identified the number of 65 surgeries as the threshold for the learning curve. The cut-off decision is based on the operation time and success rate of the wire placement rather than the effectiveness of the fracture reduction or the clinical or radiological outcomes of the patients.…”