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Supracondylar elbow fracture management (Supra Man) : a national trainee collaborative evaluation of practice
Alasdair Barrie1, Benjamin Kent1,
1Torbay and South Devon NHS Foundation Trust, Torbay Hospital, Torquay, UK.
Insights
Management of paediatric supracondylar elbow fractures varies in the UK. Paediatric consultant involvement correlated with lateral-only K-wire fixation and clinic removal, with low revision rates across all methods.
Area of Science:
- Orthopaedic Surgery
- Paediatric Orthopaedics
- Trauma Management
Background:
- Management of displaced paediatric supracondylar elbow fractures is debated.
- Current surgical and postoperative practices are not well-defined.
Purpose of the Study:
- To evaluate the surgical and postoperative management of displaced paediatric supracondylar elbow fractures across the UK.
- To identify variations in treatment protocols and outcomes.
Main Methods:
- Retrospective analysis of 972 patients with displaced paediatric supracondylar elbow fractures undergoing surgery between January 2019 and December 2019.
- Data collected via REDCap across 41 UK hospitals.
- Evaluation of fixation methods (Kirschner wire vs. manipulation under anaesthesia), fixation configurations, and timing of surgery.
Main Results:
- 94% of patients had Kirschner (K)-wire fixation; 6% had manipulation under anaesthesia (MUA) and casting.
- Crossed K-wire configuration was used in 59.5% of K-wire fixations.
- Cases supervised by paediatric orthopaedic consultants showed a higher tendency for lateral-only K-wire fixation (61%) compared to non-paediatric consultants (27%).
- Wire removal in theatre occurred in 16% of percutaneous K-wire fixations, significantly lower when supervised by paediatric consultants (3% vs. 22%).
- Revision surgery for displacement within 30 days was low (0.8% for K-wire, 6% for MUA).
Conclusions:
- Treatment strategies for paediatric supracondylar elbow fractures differ significantly across the UK.
- Paediatric orthopaedic consultant involvement is associated with specific fixation preferences (lateral-only K-wire) and management of K-wire removal.
- All fixation methods demonstrated low rates of revision surgery for displacement, indicating effective management regardless of specific technique.
Aims:
Management of displaced paediatric supracondylar elbow fractures remains widely debated and actual practice is unclear. This national trainee collaboration aimed to evaluate surgical and postoperative management of these injuries across the UK.
Methods:
This study was led by the South West Orthopaedic Research Division (SWORD) and performed by the Supra Man Collaborative. Displaced paediatric supracondylar elbow fractures undergoing surgery between 1 January 2019 and 31 December 2019 were retrospectively identified and their anonymized data were collected via Research Electronic Data Capture (REDCap).
Results:
A total of 972 patients were identified across 41 hospitals. Mean age at injury was 6.3 years (1 to 15), 504 were male (52%), 583 involved the left side (60%), and 538 were Gartland type 3 fractures (55%). Median time from injury to theatre was 16 hours (interquartile range (IQR) 6.6 to 22), 300 patients (31%) underwent surgery on the day of injury, and 91 (9%) underwent surgery between 10:00 pm and 8:00 am. Overall, 910 patients (94%) had Kirschner (K)-wire) fixation and these were left percutaneous in 869 (95%), while 62 patients (6%) had manipulation under anaesthetic (MUA) and casting. Crossed K-wire configuration was used as fixation in 544 cases (59.5%). Overall, 208 of the fixation cases (61%) performed or supervised by a paediatric orthopaedic consultant underwent lateral-only fixation, whereas 153 (27%) of the fixation cases performed or supervised by a non-paediatric orthopaedic consultant used lateral-only fixation. In total, 129 percutaneous wires (16%) were removed in theatre. Of the 341 percutaneous wire fixations performed or supervised by a paediatric orthopaedic consultant, 11 (3%) underwent wire removal in theatre, whereas 118 (22%) of the 528 percutaneous wire fixation cases performed or supervised by a non-paediatric orthopaedic consultant underwent wire removal in theatre. Four MUA patients (6%) and seven K-wire fixation patients (0.8%) required revision surgery within 30 days for displacement.
Conclusion:
The treatment of supracondylar elbow fractures in children varies across the UK. Patient cases where a paediatric orthopaedic consultant was involved had an increased tendency for lateral only K-wire fixation and for wire removal in clinic. Low rates of displacement requiring revision surgery were identified in all fixation configurations.Cite this article: Bone Joint J 2023;105-B(1):82-87.
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