The surgical management of pediatric fractures of the upper extremity
John M Flynn1, John F Sarwark, Peter M Waters
1Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Pediatric upper extremity fractures often heal well with non-surgical methods. However, surgical interventions are increasingly used for complex cases and offer improved outcomes for specific fractures, sparking ongoing debate.
Area of Science:
- Orthopaedic Surgery
- Pediatric Orthopaedics
- Traumatology
Background:
- Most pediatric upper extremity fractures are managed non-surgically with closed reduction and immobilization.
- A debate exists within orthopaedics regarding the optimal role of surgical management for these fractures.
- Recent advancements have fueled increased interest in surgical approaches.
Purpose of the Study:
- To review the current indications and evolving role of surgical management in pediatric upper extremity fractures.
- To discuss the benefits and controversies surrounding surgical versus non-surgical treatment options.
- To highlight the impact of new technologies on surgical decision-making.
Main Methods:
- Literature review of pediatric upper extremity fracture management.
- Analysis of outcomes comparing surgical and non-surgical treatments.
- Discussion of technical advancements influencing surgical practice.
Main Results:
- Surgical management has demonstrated superior results for specific fractures, like displaced supracondylar fractures.
- Indications for surgery include the need for anatomic realignment of the physis or articular surfaces.
- Both surgical and non-surgical methods yield good results in many cases, with differing expert opinions.
Conclusions:
- While non-surgical management remains standard for most pediatric upper extremity fractures, surgical options are expanding.
- Surgical intervention is crucial for specific injuries requiring precise realignment.
- Technological innovations are enhancing the feasibility and outcomes of surgical treatments for pediatric fractures.
Abstract:
The vast majority of pediatric fractures of the upper extremity can and should be treated with closed reduction, immobilization, and close follow-up. However, there is an ongoing debate in the orthopaedic community regarding the exact role of surgical management in the treatment of pediatric fractures. In the past 2 decades, surgical management of certain fractures (e.g., percutaneous pinning of displaced supracondylar fractures) has provided better results than closed management. Surgical management is clearly indicated for certain injuries, such as those requiring anatomic realignment of the physis or articular surface. Increasingly, however, surgical management is being used to maintain optimal alignment or to allow early motion. In many such cases, both nonsurgical and surgical methods have yielded good results and have vocal advocates. Certain technical advances, such as flexible intramedullary fixation and bioreabsorbable implants, have further increased enthusiasm for surgical management of pediatric fractures.
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