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Published on: August 17, 2017
Age is a predictor of elbow stiffness after type III or IV supracondylar humerus fractures
Kavish Gupta1, Mary Kate Erdman2, Ali Siddiqui3
1Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Insights
Supracondylar humerus fractures in children show that older patients experience more elbow stiffness after surgical fixation. Younger children achieve better elbow range of motion post-operation.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Skeletal Development
Background:
- Supracondylar humerus (SCH) fractures are common in children under 7 years, representing about 30% of their injuries.
- Conflicting findings exist regarding the association between patient age and SCH fracture outcomes.
- This study aims to clarify SCH fracture outcomes across different pediatric skeletal development stages.
Purpose of the Study:
- To investigate the relationship between age at skeletal maturity and outcomes of pediatric supracondylar humerus fractures.
- To analyze clinical outcomes in relation to age groups for Gartland Type III and IV SCH fractures.
- To identify age-dependent factors influencing recovery after surgical intervention for SCH fractures.
Main Methods:
- Retrospective review of 190 pediatric patients (<14 years) with Gartland III or IV SCH fractures treated between 2010-2014.
- Patients were categorized into age groups: <2 years, 4-6 years, and >8 years.
- Outcomes assessed included elbow range of motion, nerve palsy, compartment syndrome, infection, and cubitus varus following closed or open reduction with percutaneous fixation.
Main Results:
- Younger patients (<2 years) demonstrated significantly better postoperative elbow flexion (77%) and extension (96%) compared to older groups.
- Increasing age correlated with longer operative times, increased fluoroscopy duration, and a higher likelihood of nerve palsy upon admission.
- No significant differences were observed in rates of open reduction, compartment syndrome, infection, cubitus varus, or reoperation across age groups.
Conclusions:
- Older children with Gartland Type III and IV SCH fractures exhibit increased elbow stiffness after percutaneous fixation.
- Formal rehabilitation may be beneficial for older pediatric patients recovering from SCH fractures.
- Age is a critical factor influencing functional recovery and outcomes in pediatric supracondylar humerus fracture management.
Purpose:
Supracondylar humerus (SCH) fractures account for approximately 30% of injuries for those younger than 7 years of age (Cheng et al. in J Pediatr Orthop 19:344-350, 1999). Recent studies examining the association of patient age and SCH fracture outcomes have provided conflicting findings. The purpose of this study is to investigate SCH fracture outcomes in children at different ages of skeletal development.
Methods:
Retrospective review of a Level I pediatric trauma center between 2010 and 2014 was conducted. 190 patients with SCH fractures, age < 14 years, fracture type Gartland III or IV (AO/OTA 13-M 3.1 III and IV) were included. Patients were sorted into age groups: < 2 years, 4-6 years, and > 8 years. Patients were treated with either a closed or open reduction with percutaneous fixation. Clinical outcomes including postoperative elbow range of motion, nerve palsy, compartment syndrome, infection, and cubitus varus were assessed.
Results:
Patients in younger age groups were more likely to obtain postoperative full elbow flexion (< 2 years = 77%; 4-6 years = 66%; > 8 years = 43%) and full elbow extension (< 2 years = 96%; 4-6 years = 88%; > 8 years = 64%). Age was a significant predictor of nerve palsy on admission, mean operative time (< 2 years = 21.8 min; 4-6 years = 43.0 min; > 8 years = 80.7 min), and mean fluoroscopy time (< 2 years = 22.9 s; 4-6 years = 59.5 s; > 8 years = 171.9 s). There were no differences in rates of open reduction, compartment syndrome, pin tract infection, cubitus varus, or reoperation among groups.
Conclusion:
Increasing age is associated with increased elbow stiffness after percutaneous fixation of Gartland Type III and Type IV SCH fractures. Older patients with SCH fractures may benefit from formal rehabilitation.
Level Of Evidence:
III.
