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Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures: A Meta-analysis
M Bryant Transtrum1, Diego Sanchez2, Shauna Griffith3
1Department of Emergency Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas.
Insights
Obesity, severe fractures, and nerve deficits increase the likelihood of open reduction and internal fixation (ORIF) for pediatric supracondylar humerus (SCH) fractures, while less severe fractures may favor closed reduction and percutaneous pinning (CRPP).
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Trauma Surgery
Background:
- Supracondylar humerus (SCH) fractures are common in children.
- Surgical treatment involves open reduction and internal fixation (ORIF) or closed reduction and percutaneous pinning (CRPP).
- Identifying factors influencing surgical approach is crucial for optimal pediatric fracture management.
Purpose of the Study:
- To conduct a meta-analysis identifying patient, injury, and administrative factors associated with open reduction and internal fixation (ORIF) for pediatric supracondylar humerus (SCH) fractures.
- To compare factors influencing the choice between ORIF and closed reduction and percutaneous pinning (CRPP).
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched PubMed and CINAHL databases (2010-2023) for comparative studies of ORIF versus CRPP in pediatric SCH fractures.
- Utilized random-effects modeling for data aggregation after assessing study heterogeneity.
Main Results:
- Analysis of 49 studies with 94,415 pediatric patients.
- Obesity, Gartland type IV fractures, general neurological deficits, and ulnar nerve deficits were associated with higher rates of ORIF.
- Gartland type II and medially displaced fractures were associated with lower rates of ORIF.
Conclusions:
- Factors like obesity, fracture severity (displacement), and nerve deficits significantly influence the decision to use ORIF over CRPP in pediatric SCH fractures.
- Cross-pinning constructs and longer hospital stays were more common with ORIF.
Background:
Supracondylar humerus (SCH) fractures are some of the most common fractures in pediatric patients with surgery typically consisting of either open or closed reduction with internal fixation. The aim of this meta-analysis was to identify patient, injury, and administrative factors that are associated with treating pediatric SCH fractures with open techniques.
Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed and CINAHL database searches were conducted for studies from 2010 to 2023 that made direct comparisons between open reduction and internal fixation (ORIF) and closed reduction and percutaneous pinning (CRPP) for treating SCH fractures in the pediatric population. The search terms used were "pediatric" AND "SCH fracture" OR "distal humerus fracture." Screening, quality assessment, and data extraction were performed by 4 reviewers. After testing for heterogeneity between studies, data were aggregated using random-effects model analysis.
Results:
Forty-nine clinical studies were included in the meta-analysis. Summated, there were 94,415 patients: 11,329 treated with ORIF and 83,086 treated with CRPP. Factors that were significantly associated with greater rates of ORIF included obesity (p = 0.001), Gartland type IV fractures (p < 0.001), general neurological deficits (p = 0.019), and ulnar nerve deficits (p = 0.003). Gartland type II (p = 0.033) and medially displaced fractures (p = 0.011) were significantly associated with lower rates of ORIF. Secondary analysis showed cross-pinning constructs (p = 0.033) and longer hospital stays (p = 0.005) are more likely to be observed in patients undergoing ORIF compared with CRPP.
Conclusion:
This meta-analysis demonstrates that factors such as obesity, fracture displacement, and concomitant nerve deficits are more likely to require ORIF as opposed to CRPP.
Level Of Evidence:
Therapeutic Level III.
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