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Delayed treatment of supracondylar elbow fractures in children
J B Yaokreh1, T H Odehouri-Koudou, S Tembely
1Pediatric Orthopaedic Department, Yopougon-Abidjan Teaching Hospital Center, 21 BP 632, Abidjan 21, Côte d'Ivoire. enanblaodette@yahoo.fr
Insights
Delayed treatment for pediatric supracondylar elbow fractures does not increase complications. Most children experienced satisfactory outcomes even with surgical delays exceeding 48 hours.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Skeletal Injuries
Background:
- Supracondylar elbow fractures are common in children, typically requiring urgent surgical fixation.
- Treatment delays are frequent in resource-limited settings.
- The impact of delayed treatment on complication rates is a critical concern.
Purpose of the Study:
- To evaluate the perioperative complication rate and functional outcomes of pediatric supracondylar elbow fractures treated with delayed surgery ( > 48 hours).
- To determine if delayed surgical intervention influences complication rates in pediatric elbow fractures.
Main Methods:
- Retrospective review of 89 pediatric patients (ages 2-15) with severe, displaced supracondylar elbow fractures.
- Analysis of treatment delays averaging 4.5 days, with surgery performed via posterior approach with K-wire fixation.
- Assessment of postoperative complications and functional outcomes using Flynn's criteria.
Main Results:
- Satisfactory outcomes were achieved in 83.2% of patients.
- Perioperative complications occurred in 14.6%, including surgical site infection (7.8%) and iatrogenic nerve injury (3.4%).
- Long-term sequelae included cubitus varus (3.4%) and limited elbow motion (12.4%), with no compartment syndrome cases.
Conclusions:
- Delayed surgical treatment (average 4.5 days) for pediatric supracondylar elbow fractures yields satisfactory outcomes in the majority of cases.
- The study did not find an increased rate of perioperative complications associated with delayed treatment.
- These findings suggest that delayed surgical intervention is a viable option when immediate treatment is not feasible.
Background:
Supracondylar fractures are the most common elbow fractures in children and are usually treated on an emergency basis, using percutaneous pinning. However, the treatment is often delayed in areas where healthcare resources are scarce.
Hypothesis:
Delaying treatment does not influence the perioperative complication rate.
Materials And Method:
We retrospectively reviewed the medical charts of 89 children aged 2 to 15 years in whom surgery for extension-type supracondylar elbow fractures was delayed by more than 48 hours. The 53 boys and 36 girls with a mean age of 6 years 9 months had severe fracture displacement (28 stage III and 61 stage IV according to Lagrange and Rigault classification scheme). Mean time to treatment was 4.5 days (range: 2-17 days). Open reduction and crossed K-wire fixation via the posterior approach were performed in all 89 patients. Postoperative complications and sequelae were collected. Functional outcomes were evaluated using Flynn's criteria.
Results:
Outcomes were satisfactory in 74 (83.2%) of patients. Postoperative complications occurred in 13 (14.6%) patients and consisted of surgical site infection (n=7, 7.8%), iatrogenic nerve injury (n=3, 3.4%), and reoperation (n=3, 3.4%). At last follow-up after a mean of 5 months, three (3.4%) patients had cubitus varus and one had a recurrent fracture due to massaging. Elbow motion was limited in 11 (12.4%) patients. No case of compartment syndrome was recorded.
Discussion:
Despite an average time to surgery of 4.5 days, the outcome was satisfactory in 83% of cases. Delayed treatment was not associated with an increased rate of perioperative complications.
Level Of Evidence:
Level IV, retrospective study.
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