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Epidemiological Analysis of Displaced Supracondylar Fractures
Nick I Pilla1, John Rinaldi2, Mark Hatch3
1Orthopaedics, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, USA.
Insights
Pediatric supracondylar elbow fractures are common, often resulting from falls. Despite new recreational equipment, common fall mechanisms persist, necessitating operative fixation for many children.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Trauma surgery
Background:
- Supracondylar fractures are a frequent pediatric injury requiring surgical intervention.
- Understanding associated complications like vascular injury, compartment syndrome, and neurological deficits is crucial for orthopedic surgeons.
- The study aims to analyze current trends in supracondylar fractures, comparing them with historical data and considering the impact of evolving recreational equipment.
Purpose of the Study:
- To provide a qualitative overview of the epidemiology of displaced supracondylar fractures in children.
- To compare historical and current literature data with a single surgeon's case series.
- To assess if changes in recreational equipment have influenced fracture epidemiology or etiology.
Main Methods:
- A retrospective review of 75 displaced supracondylar elbow fractures was conducted.
- Data collected included patient demographics, injury mechanism, Gartland classification, and neurovascular status.
- Fracture causes, locations, and treatment timing were analyzed.
Main Results:
- The study included 42 males and 33 females, with an average age of six years.
- Falls, particularly from playground equipment (29 cases), were the primary cause.
- Common complications included pucker sign (9), nerve palsy (7), and absent pulse (4).
Conclusions:
- Pediatric supracondylar fractures remain a significant orthopedic concern, frequently requiring surgery.
- Falls from common activities like playground equipment and standing are still the leading causes.
- The study highlights the persistent nature of these injuries despite advancements in recreational equipment.
Introduction:
Supracondylar fractures are one of the most common fracture patterns sustained by children, and one of the most common injuries requiring operative fixation. Understanding the complications associated with supracondylar fractures is vital for the practicing orthopedic surgeon. This analysis of supracondylar fractures examined the clinically important aspects including vascular injury, compartment syndrome, neurological injury, brachialis entrapment, associated injuries, and etiologies of injury. Recent advances in technology have resulted in a myriad of new forms of recreational equipment for children to play with. The purpose of this study is to compare the historical literature, the current literature, and a single surgeon's sample of supracondylar fractures. In addition, this study aims to evaluate if any changes in epidemiology or etiology have occurred due to the development of new recreational equipment.
Objective:
The purpose of this study is to evaluate and provide a qualitative overview of the epidemiology of displaced supracondylar fractures, to compare historically reported numbers to more recent literature as well as a single surgeon sample, and to evaluate if changes in epidemiology or etiology have occurred due to the new recreational equipment that children use.
Methods:
Some 75 displaced supracondylar elbow fractures were reviewed. Data elements recorded from the electronic medical record (EMR) included patient age, gender, height, weight, handedness, date, time, location, mechanism, Gartland classification, concurrent injuries, and neurovascular status. Results: In this study, there were 42 males and 33 females. The average age was six years. Some 70 of the 75 patients were older than the age three. One fracture was open, nine fractures had a pucker sign, seven presented with a nerve palsy, four presented without a pulse, and seven patients presented with an additional ipsilateral distal radius fracture. All fractures were the result of a fall. Falls from playground equipment resulted in 29 fractures. There were 10 from falls off of furniture, six from falls during sports, three from falls on the stairs, and three from fall off of bikes. The remaining fractures resulted from running, tripping, falling from a toy ball, sled, tree, wagon, fence, bounce house, van, deck, power wheels car, ATV, and a go-cart. Some 64 fractures were transferred from 27 different outside hospitals. Eleven fractures presented directly to the ED. Twenty-six fractures occurred during the summer, 20 occurred in the autumn, 6 occurred in the winter, and 23 occurred during the spring. Some 35 fractures occurred at home, 30 on the school grounds, four in a gymnasium, four in a park, one at a farm show, and one in a parking lot. Some 25 fractures were treated between midnight and 8 am, 16 were treated between 8 am and 5 pm, and 34 were treated between 5 pm and midnight. Conclusion: Pediatric supracondylar fractures are common in children, and many of them require operative intervention. This study examined the most important aspects of supracondylar fractures. This update provides a look at the clinically important aspects of supracondylar fractures and compares them to previous teachings and canon. Despite the advancement and changes in recreational equipment that children are using, children are still sustaining supracondylar fractures in the most common ways including falls from playground equipment and falls from standing.
