Prognostic Factors for the Outcome of Supracondylar Humeral Fractures in Children

Abstract

Objective To detect the influence of the type of osteosynthesis, the timing of surgery, and the experience of the surgeon on the outcome of supracondylar humeral fractures in children. Methods In this study we included 97 patients aged 0 to 18 years with displaced supracondylar humeral fractures that required osteosynthesis within a time period of 5 years. In detail, unstable type II as well as type III and type IV fractures were registered. Fractures were treated with Kirschner wire fixation or with elastic stable intramedullary nailing (ESIN). A C‐arm was used to control the position of the fragments. Immobilization, if indicated after the operation, was achieved through the fitting of long‐arm plaster, or fiberglass splints. The study was carried out retrospectively. The time period to surgery, the duration of the surgery, the type of osteosynthesis, and the experience of the surgeon were determined and correlated to the incidence of complication intraoperatively, postoperatively, and during the long‐term follow‐up. The hospital's electronic archive, including all charts and radiological studies, was analyzed. Statistical significance was set at an alpha level of 0.05. Results Of the 97 supracondylar fractures in this study, 55 (56.7%) occurred in boys and 42 (43.3%) in girls; the average age was 5.8 years. The outcome of the operation was independent of the time interval between the trauma and the operation as well as the mode of transportation ( P > 0.05) because the complication rate did not differ significantly between patients who had surgery on the same day and between patients who waited for up to 2 days for surgery. Furthermore, the duration of surgery and the experience of the performing surgeon did not influence the occurrence of any complications. However, the complication rate increased after operations performed during the night shift. During the shift between 10 pm and 2 am, the incidence of paresthesia was significantly increased ( P = 0.01) compared to the shift from 7:30 am to 4:30 pm. However, no difference was detected between business and non‐business days regarding any complications. In addition, ESIN and closed reductions resulted in lower complication rates than Kirschner wire fixation and open reductions in this study population. Conclusion In our study population, patients undergoing surgery during the night shift, Kirschner wire fixation and open reduction were associated with an increased rate of complications in comparison to operations during the day, closed reduction, and ESIN. Notably, the timing of surgery and the experience of the surgeon did not have any impact on the outcome after supracondylar humeral fracture.

Lateral Condyle Fracture of the Humerus in Children: Kirschner Wire or Screw Fixation?

“…Additionally, the presence of an experienced surgeon in every operation might also play a role regarding the good results. 20 According to previous studies, 15 the indication for osteosynthesis of condylar fractures was the displacement of the fragment of at least 2 mm. In all condylar fractures, two Kirschner wires or a screw with or without a pin were used.…”

Is Supine Position Superior to Prone Position in the Surgical Pinning of Supracondylar Humerus Fracture in Children?

“…ESIN advantages include cast-free treatment after surgery and the protection of the ulnar nerve by introducing the ESIN at the proximal humerus. When compared to K-wire fixation, ESIN are rarely suggested, because they cannot be applied for more complex fractures, due to the necessity of anatomical reduction, to avoid cubitus varus [ 39 , 40 ].…”

Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours?

“…The cut-off point for optimal time passed until surgery has not been clearly defined in the literature. Wenling-Keim et al reported that the time passed until surgery was not affecting complication rates, but paresthesia was observed more frequently in cases operated between 10 am and 2 pm [ 20 ]. In contrast, Abbot et al demonstrated that the time until surgery does not affect complication rates, operative duration and open reduction rate of pediatric SHFs [ 11 ].…”