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Operative treatment of type II supracondylar humerus fractures: does time to surgery affect complications?
A Noelle Larson1, Sumeet Garg, Amanda Weller
1*Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN †Children's Hospital, Denver, CO ‡Department of Orthopedic Surgery, University of Texas Southwestern #Texas Scottish Rite Hospital for Children **Children's Medical Center, Texas Scottish Rite Hospital for Children, Dallas, TX §Department of Orthopedic Surgery, Emory University, Atlanta, GA ∥Department of Orthopedic Surgery, Brown University, Providence, RI ¶St. Christopher's Hospital for Children, Philadelphia, PA.
Insights
Delaying surgery for pediatric type II supracondylar humerus fractures did not increase major complications. This study on pediatric fractures suggests timing may not impact outcomes after pinning.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Operative pediatric supracondylar humerus fractures are increasingly managed at tertiary centers.
- Changing referral patterns necessitate efficient patient flow.
- Delayed pinning of type II fractures is sometimes employed to expedite care.
Purpose of the Study:
- To evaluate the impact of delayed surgical treatment on complication rates.
- To assess complications following closed reduction and percutaneous pinning of modified Gartland type II fractures.
- To compare outcomes between early (<24 hours) and delayed (>24 hours) surgical intervention.
Main Methods:
- Retrospective review of 399 consecutive modified Gartland type II supracondylar humerus fractures.
- Operative treatment at a tertiary referral center over four years.
- Categorization of fractures based on pinning time: within 24 hours vs. greater than 24 hours post-injury.
Main Results:
- No significant difference in major complication rates between early and delayed treatment groups.
- Overall complication rate was 4% (16 patients), with no compartment syndromes or permanent neurovascular injuries.
- Nerve injuries occurred in 3 patients, all treated within 24 hours; one ulnar palsy and two anterior interosseous nerve palsies resolved postoperatively.
Conclusions:
- Delayed surgical intervention for pediatric type II supracondylar humerus fractures does not increase major complications.
- Closed reduction and percutaneous pinning can be performed without increased risk after a delay.
- Further prospective studies are needed to identify potential subtle benefits of emergent treatment.
Background:
Because of the changing referral patterns, operative pediatric supracondylar humerus fractures are increasingly being treated at tertiary referral centers. To expedite patient flow, type II fractures are sometimes pinned in a delayed manner. We sought to determine if delay in surgical treatment of modified Gartland type II supracondylar humerus fractures would affect the rate of complications following closed reduction and percutaneous pinning.
Methods:
We performed a retrospective review of a consecutive series of 399 modified Gartland type II supracondylar fractures treated operatively at a tertiary referral center over 4 years. Mean patient age in the type II group was 5 years (range, 1 to 15 y). A total of 48% were pinned within 24 hours, 52% pinned >24 hours after the injury.
Results:
No difference was in detected in rates of major complications between the early and delayed treatment group. Four percent of patients sustained a complication (16 patients). There were no compartment syndromes, vascular injuries, or permanent nerve injuries. Complications included nerve injury (3), physical therapy referral for stiffness (3), pin site infection (2 treated with oral antibiotics, 4 treated with debridement), refracture (2), and loss of fixation or broken hardware (2). Of the 3 patients who sustained nerve injuries, all underwent surgery within 24 hours of injury. One patient developed an ulnar motor and sensory nerve palsy after fixation with crossed K-wires. This resolved by 7 weeks postoperatively. Two patients presented with an anterior interosseous nerve palsy-1 resolved 1 week after surgery, the other by 8 weeks postoperatively.
Conclusions:
Delay in surgery did not result in an increased rate of major complications following closed reduction and percutaneous pinning of type II supracondylar humerus fractures in children. Further prospective work is necessary to determine if there are subtle treatment benefits from emergent treatment of type II supracondylar humerus fractures.
Level Of Evidence:
Level III-retrospective comparative series.
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