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Daytime vs. Nighttime Surgery for Pediatric Supracondylar Humerus Fractures: A Retrospective Cohort Study
Alba Marrero Hernández1, Maryé Mercé Méndez Ojeda1, Eduardo Morales Pérez1
1Department of Orthopaedic Surgery and Traumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain.
Insights
Nighttime surgery for pediatric supracondylar humerus fractures may lead to more open reductions and reoperations, especially for complex cases. Further research is needed to confirm these findings.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Trauma Surgery
Background:
- Pediatric supracondylar humerus fractures are common injuries requiring surgical intervention.
- The impact of surgical timing on outcomes for these fractures is not well-established.
Purpose of the Study:
- To evaluate if surgical timing (daytime vs. nighttime) affects intraoperative and postoperative outcomes in pediatric supracondylar humerus fractures.
- To analyze outcomes based on fracture severity (Gartland classification).
Main Methods:
- Retrospective observational cohort study of pediatric patients (≤14 years) undergoing surgery for supracondylar humerus fractures.
- Data collected from January 2010 to December 2022 at a tertiary center.
- Patients grouped into daytime (08:00-22:00) and nighttime (22:00-08:00) surgery cohorts; outcomes included open reduction, reoperation, neuropathy, and loss of joint mobility.
Main Results:
- Nighttime surgery was linked to a significantly higher rate of open reduction (33.3% vs. 10.7%, p=0.023).
- Reoperation and postoperative neuropathy rates were higher in the nighttime group but not statistically significant.
- Complex fractures (Gartland III-IV) undergoing nighttime surgery showed a significantly higher reoperation rate (20.8% vs. 2.6%, p=0.026).
Conclusions:
- Nighttime surgery for pediatric supracondylar humerus fractures is associated with increased rates of open reduction and reoperation, particularly for complex fractures.
- Findings are exploratory due to retrospective design and limited sample size, suggesting potential residual confounding.
Abstract:
Background/Objectives: The objective was to evaluate whether surgical timing (daytime vs. nighttime) influences intraoperative and postoperative outcomes in pediatric supracondylar humerus fractures. Methods: A retrospective observational cohort study was conducted at a tertiary center. Pediatric patients aged ≤14 years who underwent surgery for supracondylar humerus fractures between January 2010 and December 2022 were included. Fractures were classified according to the Gartland system. Patients with open fractures, associated neurovascular injury, compartment syndrome, or incomplete follow-up were excluded. Primary outcomes included need for open reduction, reoperation, neuropathy, and loss of joint mobility. Patients were grouped according to the time of surgery: daytime (08:00-22:00) or nighttime (22:00-08:00). Stratified analyses were performed based on fracture severity. Results: Eighty-six patients were included: 56 underwent daytime surgery and 30 underwent nighttime surgery. Groups were comparable in age, sex, and fracture severity. Nighttime surgery was associated with a significantly higher rate of open reduction (33.3% vs. 10.7%, p = 0.023; RR = 3.11). Reoperation (16.6% vs. 5.4%, p = 0.121) and postoperative neuropathy (23.3% vs. 8.9%, p = 0.131) were more frequent in the nighttime group, although these differences were not statistically significant. In complex fractures (Gartland III-IV), nighttime surgery was associated with a significantly higher reoperation rate (20.8% vs. 2.6%, p = 0.026). Conclusions: Nighttime surgery was associated with higher rates of open reduction and reoperation, particularly in complex supracondylar humerus fractures. However, given the retrospective design and limited sample size, these findings may be influenced by residual confounding and should be interpreted as exploratory.
