Radiographic assessments of pediatric supracondylar fractures and mid-term patient-reported outcomes

Abstract

Radiographic parameters are commonly used to determine the need for surgical supracondylar humeral (SCH) fracture reduction and the postoperative quality of reduction. We studied whether such parameters are correlated with mid-term patient-reported outcome (PRO) scores in pediatric patients. We retrospectively reviewed data from 213 patients (104 girls) treated surgically for Gartland type-II (n = 84) or type-III (n = 129) SCH fractures from 2008–2016. Mean (± standard deviation) age at surgery was 5.1 ± 2.1 years. Mean time from initial treatment to outcome survey completion was 5.0 ± 2.1 years (range, 2.0–10 years). We evaluated preoperative radiographs for coronal/sagittal fracture displacement, presence of impaction/comminution, Gartland classification, and rotation. Patients, parents were asked via telephone to complete the QuickDASH (Quick Disability of the Arm, Shoulder, and Hand) and PROMIS (Patient-Reported Outcomes Measurement Information System) Strength Impact, Upper Extremity, and Pain Interference questionnaires. Parents were also asked whether the previously fractured arm appeared normal or abnormal. We evaluated postoperative radiographs for coronal/sagittal deformity, Baumann angle, and rotation and classified reductions as near complete/complete or incomplete. Anterior humeral line through the capitellum, Baumann angle in the 7.5th to 92.5th percentile of the sample, or rotation ratio between 0.85 and 1.15 were considered near complete/complete reductions; all others were considered incomplete. Bivariate analysis was used to determine whether radiographic parameters and arm appearance were associated with QuickDASH and PROMIS scores. Patients with Gartland type-III fractures had significantly greater disability on the QuickDASH at follow-up compared with those with Gartland type-II fractures ( P < .01). It is unknown if this statistical difference translates to clinical relevance. No other preoperative or postoperative radiographic parameter was significantly associated with PRO scores. There was no association between fractured arm appearance at follow-up and PRO scores. Radiographic parameters that are used to evaluate the need for and quality of pediatric SCH fracture reduction are not significantly associated with mid-term PROMIS and QuickDASH scores. LOE: Prognostic Level III.

PROMIS Utilization in Pediatric Orthopaedics: A Scoping Review

“…Ceiling and floor effects were assessed in 35.3% (n=18/51) of the included studies 8,9,19,21–23,29,31,33,39,40,43,44,49,55,58,59,61. In each of the 18 studies, significant ceiling or floor effects were considered present when ≥15% of the study cohort had reached the maximum or minimum possible score 65.…”

“…Ceiling and floor effects were assessed in 35.3% (n = 18/ 51) of the included studies. 8,9,19,[21][22][23]29,31,33,39,40,43,44,49,55,58,59,61 In each of the 18 studies, significant ceiling or floor effects were considered present when ≥ 15% of the study cohort had reached the maximum or minimum possible score. 65 Of note, the 3 most assessed PROMIS domains in terms of ceiling and floor effects were Pain Interference, Mobility, and Upper Extremity (Table 4).…”

Nonoperative Versus Operative Treatment of Type IIA Supracondylar Humerus Fractures: A Prospective Evaluation of 99 Patients

“…Previous studies have reported a 14% incidence of residual sagittal plane deformity after nonoperative management of type II SCH fractures at short-term follow-up, with equivalent functional outcomes in patients with and without this deformity 37. Radiographic parameters of any kind may not correlate with patient-reported functional outcomes at all 38. Remodeling of coronal plane deformities after fracturing at medium-term follow-up in the distal humerus has been shown to be poor,39 however data is lacking to support or refute remodeling in the sagittal plane.…”

“…37 Radiographic parameters of any kind may not correlate with patient-reported functional outcomes at all. 38 Remodeling of coronal plane deformities after fracturing at medium-term follow-up in the distal humerus has been shown to be poor, 39 however data is lacking to support or refute remodeling in the sagittal plane. In our study, some residual deformity was noted at 6-month radiographic follow-up in 62.2% of patients treated nonoperatively, compared with only 44.4% of surgical patients (P = 0.043).…”

Pediatric infrafossal fracture of the humerus: A case series

“…A value between 65° and 82° is considered normal for BA. [ 2 ] Early post-treatment BA and CA were measured right after the cast or splint was removed. A value between 5° and 15° is considered normal for CA and 45° and 57° for LCHA.…”