Timing of osteosynthesis of fractures in children changes the outcome
Danielle S Wendling-Keim1, Marion Binder2, Hans-Georg Dietz2
1Pediatric Surgery, Dr. von Hauner Childrens' Hospital, Ludwig-Maximilians-University, Munich, Germany. danielleswendling@gmail.com.
Insights
Timing of pediatric fracture surgery impacts complications. Delayed operations and longer surgical times increase risks, while transport mode also plays a role. Surgeon experience did not affect outcomes.
Area of Science:
- Pediatric Orthopedics
- Surgical Outcomes Research
- Trauma Care
Background:
- Optimal treatment for pediatric fractures requiring osteosynthesis remains debated.
- The timing of surgical intervention is a critical factor influencing outcomes.
Purpose of the Study:
- To investigate the influence of surgical timing (delay, duration, time of day) on outcomes after osteosynthesis of pediatric extremity fractures.
- To assess the impact of patient transportation mode and surgeon experience on complication rates.
Main Methods:
- Retrospective comparative study including 387 pediatric patients (1-18 years) with extremity fractures undergoing surgery.
- Analysis of patient records and radiological studies with a minimum 12-month follow-up.
- Statistical significance set at P ≤ 0.05.
Main Results:
- Delayed surgery, prolonged surgical duration, and patient transportation mode were significantly associated with higher complication rates.
- Mechanism of injury also significantly impacted outcomes.
- Complication rates were not influenced by the mode of fracture reduction, time of day, day of the week, or surgeon experience (resident vs. consultant).
Conclusions:
- Surgical timing (trauma-to-surgery interval, operation duration) and transportation mode significantly affect complication occurrence in pediatric extremity fractures.
- Mode of reduction and time of day did not influence outcomes.
- Further research focusing on specific fracture types is warranted.
Purpose:
The search for optimal treatment strategies for fractures in children that require osteosynthesis is controversial and is still being debated. A major factor that has been under discussion is the impact of the timing of surgery: the time delay between the trauma and the operation, as well as the duration of the surgical procedure, and the time of day that the operation is performed are potential factors that might influence the outcome. Therefore, the aim of our study was to investigate the influence of these factors on the outcome after osteosynthesis of diverse fractures of the extremities in children.
Methods:
In a retrospective study, 387 patients aged 1-18 years who presented with fractures of the extremities that underwent surgery were included. Patient records including radiological studies were analyzed. The follow up period lasted at least 12 months or until recovery. Statistical significance was set at an alpha level of P ≤ 0.05.
Results:
Delayed surgery, as well as a prolonged duration of surgery, and the mode of transportation of the patient significantly were related to a higher rate of complications. However, in this study, the complication rate was not found to be influenced by the mode of reduction of the fracture, or the time of day or the day of the week. A further parameter that significantly changed the outcome was the mechanism of injury. However, the rate of complications was unchanged if a resident or a consulting was the performing surgeon so that a resident can safely perform the procedure in the presence of a consultant.
Conclusion:
Timing of surgery for fractures of the extremities in children, including the time from trauma to surgery, the duration of the operation and the mode of transportation to the ER, were found to have a significant impact on the occurrence of complications in this study while the mode of reduction and the time of day did not change the outcome. Future studies with a focus on selected types of fractures are needed to further enlighten this topic.
Level Of Evidence:
Retrospective comparative study, level III.
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