Predictors of Failure of Nonoperative Treatment for Type-2 Supracondylar Humerus Fractures

Fitzgibbons, Peter G.; Bruce, Ben; Got, Christopher; Reinert, Steve; Solga, Patricia; Katarincic, Julia A.; Eberson, Craig P.

doi:10.1097/bpo.0b013e31821adca9

Cited by 28 publications

(24 citation statements)

References 11 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%

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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%

“…Four studies found casting to be viable first line management. 9,26,28,43 However, all acknowledged a proportion who would require delayed pinning in the event reduction was lost; this was not found to affect long-term outcomes. These papers did not differentiate between Gartland types II and III.…”

Section: Closed Reduction and Castingmentioning

confidence: 99%

Conservative management of displaced paediatric supracondylar fractures: a systematic review

et al. 2018

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“…Controversy remains over a consensus approach to the treatment of Gartland type 2 supracondylar humerus fractures [ 4 ]. Many fractures of this type can be evaluated in the emergency department, splinted/casted, and discharged home to be followed in the clinic or to safely undergo operative treatment on an outpatient basis, avoiding hospitalization [ 8 ]. As the healthcare environment changes and outpatient procedures are further emphasized, there may be an impetus for treatment in this fashion, as it has been shown to be safe and reliable [ 4 ].…”

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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“…The greater the degree of fracture extension, based on the anterior humeral line, the higher the risk of failure of cast treatment. This was found to be of significance [29]. Other factors in the same study which were found to correlate with failure of treatment include increased width of soft tissue shadow of the upper arm.…”

Section: Gartland Type IImentioning

confidence: 65%

Supracondylar Fractures of the Humerus in Children: Review of Management and Controversies

Dabis¹,

Daly²,

Gelfer³

2016

Orthop Muscular Syst

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Upper extremity fractures account for up to 90% of paediatric fractures. Amongst these fractures, Supracondylar Humerus fractures are one of the most common requiring surgical intervention and have a high prevalence of associated short term complications such as nerve injuries and long term complications such as cubitus varus. The epidemiology, classifications, clinical evaluation and complications of this fracture is hereby comprehensively reviewed along with controversies in management and available guidelines.

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Predictors of Failure of Nonoperative Treatment for Type-2 Supracondylar Humerus Fractures

Abstract: Despite adequate reduction and casting of type-2 supracondylar fractures, some fractures will lose reduction and require delayed pinning. The degree of extension of the distal fragment at the time of injury may help to predict the likelihood of failure of nonoperative treatment.

Cited by 28 publications

References 11 publications

Conservative management of displaced paediatric supracondylar fractures: a systematic review

Conservative management of displaced paediatric supracondylar fractures: a systematic review

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

Supracondylar Fractures of the Humerus in Children: Review of Management and Controversies

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