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Delay increases the need for open reduction of type-III supracondylar fractures of the humerus
P J Walmsley1, M B Kelly, J E Robb
1The Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, UK. pjwalmsley@rcsed.ac.uk
Insights
Delaying surgery for type-III supracondylar humerus fractures increases the need for open reduction. Early surgical intervention is recommended to avoid complications and prolonged operating times in pediatric patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Type-III supracondylar humerus fractures are common in children.
- Previous studies suggested delayed management does not impact outcomes.
Purpose of the Study:
- To investigate the effect of surgical timing on peri-operative complications and the need for open reduction in type-III supracondylar humerus fractures.
- To evaluate the correlation between delayed surgery and operating time.
Main Methods:
- Retrospective study of 171 children with closed type-III supracondylar humerus fractures.
- Patients divided into two groups: treated <8 hours and >8 hours from presentation.
- Comparison of complication rates, need for open reduction, and operating time.
Main Results:
- No significant difference in peri-operative complication rates between early (<8 hours) and delayed (>8 hours) treatment groups.
- Children with delayed treatment were significantly more likely to require open reduction (33.3% vs 11.2%, p < 0.05).
- A weak correlation was observed between delayed surgery and increased operating time (p = 0.062).
Conclusions:
- While overall complication rates may not differ, delayed surgical management of type-III supracondylar humerus fractures increases the likelihood of requiring open reduction.
- Early surgical intervention is still recommended for these pediatric fractures to potentially minimize the need for open reduction and operating time.
Abstract:
Recent reports have suggested that a delay in the management of type-III supracondylar fractures of the humerus does not affect the outcome. In this retrospective study we examined whether the timing of surgery affected peri-operative complications, or the need for open reduction. There were 171 children with a closed type-III supracondylar fracture of the humerus and no vascular compromise in our study. They were divided into two groups: those treated less than eight hours from presentation to the Accident and Emergency Department (126 children), and those treated more than eight hours from presentation (45 children). There were no differences in the rate of complications between the groups, but children waiting more than eight hours for reduction were more likely to undergo an open reduction (33.3% vs 11.2%, p < 0.05) and there was a weak correlation (p = 0.062) between delay in surgery and length of operating time. Consequently, we would still recommend treating these injuries at the earliest opportunity.
