Pediatric Orthopedic Emergencies

Chasm, Rose M.; Swencki, Sharon A.

doi:10.1016/j.emc.2010.06.003

Cited by 16 publications

(4 citation statements)

References 47 publications

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“… Among the fractures around the elbow in the Paediatric age group, Supracondylar fracture of Humerus is the most common [8,9] . Neurovascular complications are commonly associated with these fractures [10,11] .…”

Section: Discussionmentioning

confidence: 99%

A prospective study of crossed versus lateral pinning for displaced extension-type supracondylar fractures of humerus

KN¹,

Ramachandra²,

Veerabhadra³

et al. 2018

Int. J. Orthop. Sci.

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Background: Pediatric age group has the highest incidence of supracondylar fracture of humerus, the most common being the extension type. A precise evaluation and planning is required for deciding the modality of treatment for these fractures. They are most widely managed by utilizing two methods; crossed pinning and lateral pinning. The task at hand remains to determine the superiority of either of these techniques over the other. Materials and Methods: A prospective, single blinded, randomized control trial with 68 cases, out of which 46 were boys and 22 were girls was conducted. Mean age group of study was 8.4 years. Type III supracondylar fractures were included in this study based on Gartland classification. Detailed postoperative primary assessment for major loss of reduction and iatrogenic ulnar nerve injury was done. Clinical outcome, elbow range of motion, radiographic measurement, Flynn's grading and complications were the secondary parameters which were assessed. Results: Both groups exhibited no major loss of reduction. Change of Boumann angle was statistically insignificant. Metaphysial-Diaphysial angle, Flynn grade, carrying angle and total elbow range of motion between the two groups showed no statistically significant difference. Conclusion: Lateral pin fixation offers parallel results in terms of functional and radiological outcomes and nearly equal mechanical stability compared to medial-lateral pinning without the added shortcoming of possibility of iatrogenic ulnar nerve injury.

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Section: Discussionmentioning

confidence: 99%

A prospective study of crossed versus lateral pinning for displaced extension-type supracondylar fractures of humerus

KN¹,

Ramachandra²,

Veerabhadra³

et al. 2018

Int. J. Orthop. Sci.

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“…Although ultimately rare, greenstick fractures typically occur at the proximal metaphysis of the tibia. This fracture type is characterized with a disrupted cortical bone on the convex side of the long bone, whereas the opposite cortical bone is intact [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Greenstick fractures of the proximal metaphyseal tibia: a retrospective multicenter study on the outcome after non-surgical or surgical treatment and the occurrence of posttraumatic tibia valga

Weigert

Lieber

Buergener

et al. 2022

Eur J Trauma Emerg Surg

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Purpose This study investigates the occurrence of (progressive) posttraumatic valgus deformity after proximal metaphyseal greenstick fractures of the tibia in young children, and whether non-surgical or surgical treatment influences the outcome. Methods A retrospective multi-center study was conducted including surveys and X-rays of patients < 12 years of age with a fracture of the proximal tibia. In patients with greenstick fractures, the medial proximal tibia angle (MPTA; defined as the angle of the tibial axis and the joint-line of the knee) was measured at trauma, short-term follow-up (st-FU), and long-term FU (lt-FU) as defined for the 2 groups of non-surgically and surgically treated patients. Results Of a total of 322 fractures, 91 were greenstick fractures. Of these, 74 were treated non-surgically and 17 were treated surgically. The mean MPTA at trauma of non-surgically treated patients was 91.14°, and of surgically treated patients was 95.59° (p = 0.020). The MPTA in non-surgically treated patients significantly increased from the timepoint of trauma to st-FU (92,0°; p = 0.030), and lt-FU (92,66°, p = 0.016). In surgically treated patients, the MTPA improved after trauma to st-FU (94.00°; p = 0.290), and increased again to lt-FU (96.41°; p = 0.618). Conclusion Progressive valgus deformity after greenstick fractures of the proximal tibia occurred in both non-surgically and surgically treated patients. In non-surgically treated patients, this was of statistical, but not clinical significance. In surgically treated patients, progressive valgus was observed after metal removal for an unknown reason. Therefore, surgery for proximal greenstick fractures of the tibia in this age group has only limited effect and may be indicated only in selected cases. Further studies are needed to explain the responsible mechanisms. Level of evidence III, retrospective analysis.

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“…It was believed that early surgical intervention before the onset of significant swelling would lower complication rates such as compartment syndrome, the need for open reduction, iatrogenic nerve injury, and infection. 5,6 However, many studies have compared early and delayed treatment of these injuries with most showing no difference in complication rates. [7][8][9][10][11][12][13][14][15] Two studies have shown a higher rate of open reduction in those treated in a delayed manner.…”

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confidence: 99%

“…Classically, SCH fractures were considered orthopaedic emergencies. It was believed that early surgical intervention before the onset of significant swelling would lower complication rates such as compartment syndrome, the need for open reduction, iatrogenic nerve injury, and infection 5,6. However, many studies have compared early and delayed treatment of these injuries with most showing no difference in complication rates 7–15.…”

mentioning

confidence: 99%

Does Shorter Time to Treatment of Pediatric Supracondylar Humerus Fractures Impact Clinical Outcomes?

Sullivan

Wahlig

Broida

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Treatment of supracondylar humerus (SCH) fractures within 18 hours of presentation is a tracked quality metric for ranking of pediatric hospitals. This is in contrast with literature that shows time to treatment does not impact outcomes in SCH fractures. We aim to determine whether an 18-hour cutoff for pediatric supracondylar humerus fracture treatment is clinically significant by comparing the complication risks ofpatients on either side of this timepoint. Our hypothesis is that there will be no statistically significant differences based on time to treatment. Methods: A retrospective review of clinical outcomes was performed for 472 pediatric patients who underwent surgical management of isolated supracondylar humerus fractures between 1997 and 2022 at a single level I pediatric trauma hospital. The cohort was split based on time to surgery (within or ≥18 h from Emergency Department admission). Results: Surgical treatment occurred within 18 hours of arrival in 435 (92.2%) patients and after 18 hours in 37 (7.8%) patients. Mean age was 5.6±2.2 years and 51.5% of patients were female. Gartland fracture classification was type II [n=152 (32.3%)], type III [n=284 (60.3%)], type IV [n=13 (2.8%)], or flexion-type [n=18 (3.8%)]. There were no differences in demographic characteristics or fracture classification between cohorts. Fractures in the ≥18-hour cohort were treated more commonly with 2 pins (62.2% vs. 38.5%, P=0.04). There were no statistically significant differences in open versus closed reduction, utilization of medial pins, or postoperative immobilization between cohorts. We were unable to detect any differences in postoperative complications, including non-union, delayed union, stiffness, malunion, loss of reduction, iatrogenic nerve injury, or infection. This remained true when type II fractures were excluded. Conclusions: Using an arbitrary time cutoff of <18 hours does not influence clinical outcomes in the surgical treatment of SCH fractures. This held true when type II fractures were excluded. For this reason, we recommend modification to the USNWR guidelines to decrease emphasis on time-to-treatment of SCH fractures. Level of Evidence: Level III

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Pediatric Orthopedic Emergencies

Cited by 16 publications

References 47 publications

A prospective study of crossed versus lateral pinning for displaced extension-type supracondylar fractures of humerus

A prospective study of crossed versus lateral pinning for displaced extension-type supracondylar fractures of humerus

Greenstick fractures of the proximal metaphyseal tibia: a retrospective multicenter study on the outcome after non-surgical or surgical treatment and the occurrence of posttraumatic tibia valga

Does Shorter Time to Treatment of Pediatric Supracondylar Humerus Fractures Impact Clinical Outcomes?

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