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Standardizing a Postoperative Protocol for Supracondylar Humerus Fractures
Jessica H Heyer1, Jason B Anari, Keith D Baldwin
1Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Standardizing postoperative protocols for pediatric supracondylar humerus fractures is crucial. This study found no significant differences in outcomes or complications among liberal, intermediate, and conservative elbow motion protocols.
Area of Science:
- Orthopaedic Surgery
- Pediatric Orthopaedics
- Trauma Surgery
Background:
- Supracondylar humerus fractures are the most common surgically treated upper extremity fractures in children.
- A standardized postoperative protocol is currently lacking.
- Advanced practice providers are increasingly involved in fracture care, necessitating standardized protocols.
Purpose of the Study:
- To compare outcomes following operative fixation of supracondylar humerus fractures using three distinct postoperative management protocols.
- To evaluate the impact of early versus delayed unrestricted elbow motion on patient outcomes.
Main Methods:
- Retrospective analysis of 100 pediatric patients with supracondylar humerus fractures (2014-2015).
- Classification of postoperative protocols into liberal, intermediate, and conservative based on the timing of unrestricted elbow motion.
- Evaluation of range of motion, functional elbow motion, clinical function, and postoperative complications.
Main Results:
- No significant differences were observed in patient demographics or fracture types across the three protocol groups.
- Range of motion, functional motion, and clinical elbow function showed no statistically significant differences between groups.
- Zero postoperative complications, including reoperation, refracture, or infection, were reported in any group.
Conclusions:
- The choice of postoperative protocol (liberal, intermediate, or conservative) did not impact outcomes or complication rates for operatively treated supracondylar humerus fractures.
- A standardized liberal protocol may be considered for efficiency in busy orthopaedic centers.
Background:
Supracondylar humerus fractures are the most commonly operated upper extremity fracture in pediatric orthopaedics, yet there does not currently exist a standardized recommendation for a postoperative protocol. As advanced practice providers take on larger roles in the care of fracture patients, it may alleviate confusion to standardize postoperative protocols. The aim of this study was to compare outcomes between three different postoperative management protocols following operative fixation of supracondylar humerus fractures.
Methods:
This is a retrospective study of all patients who underwent operative fixation of a supracondylar humerus fracture during the 2014 to 2015 academic year. Postoperative protocols were classified as either "liberal," "intermediate," or "conservative," based on how quickly the surgeon allowed unrestricted motion of the elbow postoperatively. Patients were evaluated for range of motion, functional elbow motion, and elbow clinical function, as well for postoperative complications. Univariate analysis was conducted to detect the differences in outcomes between protocol groups with P<0.01 considered significant.
Results:
One hundred patients were included in the final analysis, with 17 patients in the liberal group, 50 in the intermediate group, and 33 in the conservative group. There were no differences in patient population (age, sex, fracture type, concomitant nerve palsy, ipsilateral injuries, or physical therapy referrals) between the groups (P>0.01). There were no differences in range of motion, functional motion, or elbow clinical function (P>0.01) between the postoperative protocol groups. There were no postoperative complications (unplanned return to operating room, refracture, need for fixation revision, or infection) in any patient.
Conclusions:
There were no differences in postoperative complications or outcomes between the patients in the liberal, intermediate, or conservative protocol groups. In an efficiency-focused era, we conclude that a standardized liberal protocol be considered at a busy orthopaedic center.
Level Of Evidence:
This study is a level III therapeutic study. It is a retrospective study that compares the outcomes after following 1 of 3 different postoperative protocols.
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