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Pediatric supracondylar humerus fractures and vascular injuries: A cross-sectional study based on the National Trauma
Andrew Nordin1, Junxin Shi2,3, Brian Kenney1
1Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Pediatric supracondylar humerus fractures rarely involve vascular injury (0.3%). When vascular injury occurs, treatment is faster, length of stay is longer, and care is concentrated in pediatric trauma centers.
Area of Science:
- Orthopedic surgery
- Pediatric trauma
- Vascular injury
Background:
- Supracondylar humerus (SCH) fractures are common in children.
- Associated vascular injuries require specific management considerations.
- Understanding injury patterns and treatment pathways is crucial for optimizing outcomes.
Purpose of the Study:
- To determine the incidence of vascular injury in pediatric SCH fractures.
- To analyze the mechanisms of injury and treatment settings.
- To evaluate the time to operating room (OR) and length of stay (LOS).
Main Methods:
- Analysis of the 2007-2014 National Trauma Data Bank (NTDB) for pediatric patients (<18 years) with isolated SCH fractures.
- Inclusion of both operative and non-operative management.
- Statistical comparison of demographics, injury mechanisms, vascular injury presence, OR time, and LOS using Chi square and Student's t-tests.
Main Results:
- A total of 53,571 pediatric SCH fractures were identified.
- Vascular injuries were present in 0.3% of cases, significantly higher in open fractures.
- Patients with vascular injuries experienced longer LOS and shorter times to OR, and were more often treated in teaching hospitals and pediatric level 1 trauma centers.
Conclusions:
- The incidence of vascular injury associated with pediatric SCH fractures is low (0.3%).
- Pediatric SCH fractures with vascular compromise are predominantly managed in specialized pediatric level 1 trauma centers.
Objective:
Supracondylar humerus (SCH) fractures represent one of the most commonly treated fractures. We sought to determine: 1) how often SCH fractures are associated with vascular injury; 2) mechanism of injuries; 3) where cases are treated 4) time to operating room (OR); and 5) length of stay (LOS).
Methods:
The 2007-2014 National Trauma Data Bank (NTDB) data were analyzed for all patients <18 years of age who presented with an isolated supracondylar humerus fracture, with or without an associated vascular injury. Both non-operative and operative management were included. Main outcome measures were demographics, mechanism of injury, presence of vascular injury, time to OR, number of OR procedures, type of treating facility, and LOS. Comparisons were performed using Chi square test for categorical variables and Student's t-test for continuous variables.
Results:
We identified a total of 53,571 pediatric patients over eight years with SCH fractures. Vascular injuries occurred in 149 patients (0.3%), which were significantly more common with open fractures (p < 0.001). Patients with vascular injuries had significantly longer LOS (3.5 days v 1.4 days; p < 0.001) and shorter times to the OR (4.7 h v 10.4 h; p < 0.001), and were more likely to be treated in teaching hospitals and pediatric level 1 trauma centers (p = 0.037).
Conclusion:
The percentage of vascular injuries associated with SCH fractures in pediatric patients remains low (0.3%). The majority of pediatric patients with these injuries are treated at level 1 pediatric trauma centers.
Level Of Evidence:
Therapeutic, III.
