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Fracture Classification Does Not Predict Functional Outcomes in Supracondylar Humerus Fractures: A Prospective Study
Justin Ernat1, Christine Ho, Robert L Wimberly
1*Tripler Army Medical Center, Orthopedic Surgery Service, Honolulu, HI †Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children and Children's Medical Center of Dallas, TX.
Journal of Pediatric Orthopedics
|October 25, 2016
Summary
Pediatric supracondylar humerus fracture (SCHFX) surgery leads to excellent functional outcomes. Fracture type and displacement direction do not impact these results in children.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Limited prospective data exists on functional outcomes following surgical management of supracondylar humerus fractures (SCHFXs).
- The relationship between fracture pattern and long-term patient outcomes in pediatric SCHFXs has not been prospectively evaluated.
Purpose of the Study:
- To prospectively evaluate fracture classification and functional outcomes in pediatric patients with extension-type SCHFXs.
- To utilize validated outcome measures to assess functional recovery after operative treatment.
Main Methods:
- Prospective enrollment of 132 consecutive pediatric patients with operative extension-type SCHFXs over 3 years.
- Fracture classification using the modified Gartland system; functional outcomes assessed with Pediatric Outcomes Data Collection Instruments (PODCI) and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH).
- Exclusion of flexion-type fractures, multidirectionally unstable fractures, and follow-up <10 weeks; statistical analysis of fracture pattern and outcome.
Main Results:
- The cohort (average age 6.7 years) demonstrated excellent functional outcomes at an average follow-up of 12.4 weeks (PODCI: 93.6, QuickDASH: 11.4).
- No significant differences in functional outcome scores were observed between Gartland type II and type III fractures.
- The direction of fracture displacement (posteromedial, posterolateral, posterior) did not influence functional outcomes.
Conclusions:
- This study is the first to prospectively correlate fracture classification and functional outcomes in pediatric extension-type SCHFXs treated operatively.
- Operative treatment of pediatric extension-type SCHFXs generally results in excellent functional outcomes.
- Gartland classification and the direction of displacement do not appear to affect functional outcomes in this patient population.
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