Obesity’s Influence on Operative Management of Pediatric Supracondylar Humerus Fractures

Li, Neill Y.; Bruce, William J.; Joyce, Cara; Decker, Norman M.; Cappello, Teresa

doi:10.1097/bpo.0000000000001126

Cited by 29 publications

(25 citation statements)

References 25 publications

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“…These trends have been demonstrated among other conditions as well, with decreased access to appropriate treatment centers and worse trauma outcomes. 21-23…”

Section: Discussionmentioning

confidence: 99%

Pediatric Digit Replantation Following Traumatic Amputation: Nationwide Analysis of Patient Selection, Outcomes, and Cost

Kleiner

Harris

et al. 2019

Hand (New York, N,Y.)

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Background: Indications for replantation following traumatic digit amputations are more liberal in the pediatric population than in adults, but delineation of patient selection within pediatrics and their outcomes have yet to be elucidated. This study uses a national pediatric database to evaluate patient characteristics and injury patterns involved in replantation and their outcomes. Methods: The Healthcare Cost and Utilization Project Kid’s Inpatient Database was queried for traumatic amputations of the thumb and finger from 2000 to 2012. Participants were separated into those who underwent replantation and those who underwent amputation. Patients undergoing replantation were further divided into those requiring revision amputation and/or microvascular revision. Patient age, sex, insurance, digit(s) affected, charges, length of stay, and complications were extracted for each patient. Results: Traumatic digit amputations occurred in 3090 patients, with 1950 (63.1%) undergoing revision amputation and 1140 (36.9%) undergoing replantation. Younger patients, those with thumb injuries, females, and those covered under private insurance were significantly more likely to undergo replantation. Cost, length of stay, and in-hospital complications were significantly greater in replantation patients than in those who had undergone amputation. Following replantation, 237 patients (20.8%) underwent revision amputation and 209 (18.3%) underwent vascular revision, after which 58 required revision amputation. Risk of revision following replantation involved older patients, males, and procedures done recently. Conclusions: Pediatric patients who underwent replantation were significantly younger, female, had thumb injuries, and were covered by private insurance. Our findings demonstrate that in addition to injury factors, demographics play a significant role in the decision for finger replantation and its outcomes.

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“…These trends have been demonstrated among other conditions as well, with decreased access to appropriate treatment centers and worse trauma outcomes. 21-23…”

Section: Discussionmentioning

confidence: 99%

Pediatric Digit Replantation Following Traumatic Amputation: Nationwide Analysis of Patient Selection, Outcomes, and Cost

Kleiner

Harris

et al. 2019

Hand (New York, N,Y.)

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“…Closed reduction or CRPP followed by plaster immobilization move secondary and require resumption of reduction or ORIF. ORIF has become a commonly used method in obese children and the frequency increases with age in those with private insurance [14]. Parents of obese children with SHF should be aware of the risk of therapeutic guidance in the direction of surgery and the need for surgery as an effective and comfortable solution in postoperative prognosis.…”

Section: Obesity and Shfmentioning

confidence: 99%

“Double X” Fixation for Rare and Particular Pediatric Supracondylar Humerus Fractures

Burnei

Raducan

Enache

et al. 2021

MRAJ

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Background Context. The presence of special, rare and various forms which we can encounter when treating supracondylar humeral fractures (SHF) in children, call into question what therapeutic methods can be used to increase the effectiveness of the treatment applied. The aim of this paper is to present the results obtained by using double cross-fixation, "in double X", by closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF) in treating rare and particular forms. Comments and opinions on "double X" method and other cross or side configurations are presented. Patient Sample. All patients with rare and particular forms presented in this article, were operated during 2001-2020 in state and private hospitals. Fixation in "double X" was used either by CRPP and ORIF. The epitrochlear approach (EA) was performed in cases where stability by CRPP could not be ensured or when there were clear signs of ulnar nerve damage. The minimal medial-approach (mMA) highlights the epitrochlea and the fracture of the medial pylon; it has the role of anatomically reducing the medial pylon, thinner and very unstable in rare and particular forms. During 1982-2020 we consulted, treated and evaluated patients with SHF to whom all known treatment methods were applied: orthopedic reduction and immobilization in plaster cast, CRPP, ORIF, minimal-open reduction and internal fixation (mORIF) by mMA and external fixator. Internal fixation was done by the techniques of Judet, San Antonio, San Diego, Dorgan, in “X” and “double X”. In 2001, I introduced "double X" fixation to better stabilize anatomical reductions that showed signs of instability during intraoperative verification. All indications given in the study protocol have been made in accordance with the regulations mentioned in the experimental program. Results. All SHFs operated by CRPP and ORIF by “double X” were cured and satisfactory and good results were obtained in the neglected types operated between 14 and 60 days and good and excellent results were obtained in the rare forms. Conclusions. “Double X” fixation gives the best stabilization and postoperatively there is no need for immobilization in a plaster cast. Recovery may begin the day after surgery. Keywords: supracondylar fractures, child elbow pathology, cross-fixation, lateral fixation, healing and recovery after 30-45 days.

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“…Chang et al 23 also found that obese patients had a higher risk of postoperative varus malalignment and pin complications after surgical treatment of type III supracondylar humerus fractures. Li et al 24 found obese children between the ages of 8 and 12 were 4 times more likely than nonobese patients to require an open reduction in the setting of a supracondylar humerus fracture. They hypothesized that the excess subcutaneous fat was a likely cause for the difficulty in fracture manipulation along with the more severe injury patterns as found by Seeley et al 22 Gilbert et al 25 found that obese patients were more than twice as likely to sustain a fracture of the physis than nonobese patients in lower extremity fractures stemming from blunt trauma.…”

Section: Effects Of Obesity In Pediatric Traumamentioning

confidence: 99%

The Role of Obesity in Pediatric Orthopedics

et al. 2019

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Pediatric obesity has become a worldwide epidemic and leads to notable effects on the developing skeleton that can have lifelong implications. Obesity in the pediatric population alters bone metabolism, increasing the risk for fracture. It can alter the presentation of common pediatric orthopaedic conditions such as scoliosis. Obesity also leads to changes in the patterns and severity of pediatric fractures as well as alters conservative fracture treatment due to increased displacement risk. Obese pediatric trauma patients place a high burden on the nationwide hospital system in a variety of ways including the increased risk of perioperative complications. Obesity is modifiable, and addressing the issue can improve the orthopaedic and overall health of children.

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Obesity’s Influence on Operative Management of Pediatric Supracondylar Humerus Fractures

Abstract: Level IV-case series.

Cited by 29 publications

References 25 publications

Pediatric Digit Replantation Following Traumatic Amputation: Nationwide Analysis of Patient Selection, Outcomes, and Cost

Pediatric Digit Replantation Following Traumatic Amputation: Nationwide Analysis of Patient Selection, Outcomes, and Cost

“Double X” Fixation for Rare and Particular Pediatric Supracondylar Humerus Fractures

The Role of Obesity in Pediatric Orthopedics

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