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Pediatric Supracondylar Humerus Fractures: Treatment by a Pediatric Orthopedic Surgeon Versus a Non-pediatric
Joshua Chen1, Ally Yang2, Melanie Patterson3
1Orthopedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Insights
Pediatric supracondylar humerus fractures (PSCHF) treated by pediatric and non-pediatric orthopedic surgeons showed equal outcomes. Both surgeon types are skilled in treating these common childhood fractures, ensuring good results.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Supracondylar humerus fractures are the most common surgically treated fractures in children.
- There's a growing trend of transferring these fractures to pediatric specialists.
- This study investigates outcomes based on surgeon specialization.
Purpose of the Study:
- Compare outcomes of surgically treated pediatric supracondylar humerus fractures (PSCHF) between pediatric and non-pediatric orthopedic surgeons.
- Assess radiographic reduction, pin usage, surgical time, Flynn criteria outcomes, and complications.
- Determine if significant outcome differences exist based on surgeon specialization.
Main Methods:
- Study included 47 consecutive pediatric patients (average age 5.5 years) with PSCHF.
- Intervention: closed reduction and percutaneous pinning.
- Outcomes measured: radiographic reduction (Bauman's angle, anterior humeral line), K wire usage, surgical time, Flynn criteria, and complications.
Main Results:
- Excellent and similar radiographic reductions between both surgeon types.
- Pediatric surgeons used more medial K wires but fewer total K wires; surgery time was shorter.
- Flynn criteria outcomes were similar (equal excellent/good results); no complications observed for either group.
Conclusions:
- Treatment outcomes for displaced PSCHF are equivalent between pediatric and non-pediatric orthopedic surgeons.
- Both specialist and non-specialist orthopedic surgeons possess adequate training to manage these fractures.
- Findings support informed clinical decision-making regarding surgeon choice for PSCHF.
Introduction:
Supracondylar humerus fractures are the most common surgically treated fracture in children. National trends have demonstrated an increase in transfers of supracondylar fractures to pediatric hospitals due to the perception that supracondylar fractures need to be treated by pediatric specialists. The objectives of the study are to compare the outcomes of surgically treated pediatric supracondylar humerus fractures (PSCHF) between a pediatric orthopedic surgeon and a non-pediatric orthopedic surgeon at a single academic medical center; to assess radiographic reduction, the number of pins used, surgical time, Flynn criteria outcomes, and complications associated with PSCHF treatment by both types of surgeons; to determine if there is a significant difference in outcomes between pediatric and non-pediatric orthopedic surgeons in the treatment of PSCHF.
Methods:
Forty-seven consecutive pediatric patients, with an average age of 5.5 years old, who had undergone surgical correction for supracondylar humerus fractures during 2019 were included in this study. The intervention performed was closed reduction and percutaneous pinning. The main outcome measured: radiographic reduction on the AP and lateral X-ray view, number of K wires used, use of a medial K wire, time of surgery, the Flynn criteria, and complications. The Human Research Protection Program (HRPP) at Penn State approval was obtained.
Results:
Radiographic reductions as measured by Bauman's angle and the position of the anterior humeral line were excellent and similar between surgeons. The pediatric orthopedic surgeon used more medial K wires (p=0.0007), fewer K wires (p=0.0065), and the length of surgery was shorter (p=0.019). The Flynn criteria were similar with equal excellent and good results. For both surgeons, no complications such as loss of reduction, infection, iatrogenic nerve injury, compartment syndrome, or cubitus varus occurred.
Conclusions:
Outcomes of treatment of displaced PSCHF by the pediatric and non-pediatric orthopedic surgeons were equal. The results of this study reaffirm the assertion that both pediatric and non-pediatric orthopedic surgeons have sufficient training and skill to treat these common fractures, thereby contributing to a more informed decision-making process in clinical practice.
