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Displaced supracondylar fractures of the humerus in children. Audit changes practice
L J O'Hara1, J W Barlow, N M Clarke
1Southampton General Hospital, England.
Insights
Adhering to surgical guidelines for pediatric humerus fractures significantly improves outcomes. Following recommendations for experienced management and Kirschner (K-) wire stabilization reduces reoperations and malunion in children.
Area of Science:
- Pediatric Orthopedics
- Traumatology
- Surgical Guidelines
Background:
- Supracondylar humerus fractures are common in children.
- Extension-type fractures require careful management to avoid complications.
- Previous reviews prompted the development of specific treatment guidelines.
Purpose of the Study:
- To audit the effectiveness of established guidelines for displaced, extension-type supracondylar humerus fractures in children.
- To assess the impact of guideline adherence on surgical outcomes.
- To refine management protocols for these injuries.
Main Methods:
- A retrospective audit of 71 pediatric patients with supracondylar humerus fractures.
- Fracture classification using the Gartland system (Wilkins modification).
- Assessment of adherence to guidelines on surgeon experience, K-wire stabilization, and K-wire configuration.
Main Results:
- Guidelines were followed in 52 of 71 cases.
- Adherence to guidelines resulted in zero reoperations and no malunion.
- Non-adherence led to reoperations in over one-third of cases and six instances of varus deformity.
- 11 patients had unsatisfactory results due to failure to follow guidelines.
Conclusions:
- Strict adherence to surgical guidelines for pediatric supracondylar humerus fractures leads to significantly better outcomes.
- The proposed protocol, emphasizing experienced management and appropriate K-wire stabilization, is effective.
- Implementing these guidelines is crucial for minimizing complications and improving treatment success.
Abstract:
We performed an audit of 71 children with consecutive displaced, extension-type supracondylar fractures of the humerus over a period of 30 months. The fractures were classified according to the Wilkins modification of the Gartland system. There were 29 type IIA, 22 type IIB and 20 type III. We assessed the effectiveness of guidelines proposed after a previous four-year review of 83 supracondylar fractures. These recommended that: 1) an experienced surgeon should be responsible for the initial management; 2) closed or open reduction of type-IIB and type-III fractures must be supplemented by stabilisation with Kirschner (K-) wires; and 3) K-wires of adequate thickness (1.6 mm) must be used in a crossed configuration. The guidelines were followed in 52 of the 71 cases. When they were observed there were no reoperations and no malunion. In 19 children in whom they had not been observed more than one-third required further operation and six had a varus deformity. Failure to institute treatment according to the guidelines led to an unsatisfactory result in 11 patients. When they were followed the result of treatment was much better. We have devised a protocol for the management of these difficult injuries.