Complications With Surgical Treatment of Pediatric Supracondylar Humerus Fractures: Does Surgeon Training Matter?
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
01 Jan 2022
01 Jan 2022
Historique:
pubmed:
22
9
2021
medline:
15
12
2021
entrez:
21
9
2021
Statut:
ppublish
Résumé
National trends reveal increased transfers to referral hospitals for surgical management of pediatric supracondylar humerus (SCH) fractures. This is partly because of the belief that pediatric orthopaedic surgeons (POs) deliver improved outcomes compared with nonpediatric orthopaedic surgeons (NPOs). We compared early outcomes of surgically treated SCH fractures between POs and NPOs at a single center where both groups manage these fractures. Patients ages 3 to 10 undergoing surgery for SCH fractures from 2014 to 2020 were included. Patient demographics and perioperative details were recorded. Radiographs at surgery and short-term follow-up assessed reduction. Primary outcomes were major loss of reduction (MLOR) and iatrogenic nerve injury (INI). Complications were compared between PO-treated and NPO-treated cohorts. Three hundred and eleven fractures were reviewed. POs managed 132 cases, and NPOs managed 179 cases. Rate of MLOR was 1.5% among POs and 2.2% among NPOs (P=1). Rate of INI was 0% among POs and 3.4% among NPOs (P=0.041). All nerve palsies resolved postoperatively by mean 13.1 weeks. Rates of reoperation, infection, readmission, and open reduction were not significantly different. Operative times were decreased among POs (38.1 vs. 44.6 min; P=0.030). Pin constructs were graded as higher quality in the PO group, with a higher mean pin spread ratio (P=0.029), lower rate of "C" constructs (only 1 "column" engaged; P=0.010) and less frequent crossed-pin technique (P<0.001). Multivariate analysis revealed minimal positive associations only for operative time with MLOR (odds ratio=1.021; P=0.005) and INI (odds ratio=1.048; P=0.009). Postsurgical outcomes between POs and NPOs were similar. Rates of MLOR were not different between groups, despite differences in pin constructs. The NPO group experienced a marginally higher rate of INI, though all injuries resolved. Pediatric subspecialty training is not a prerequisite for successfully treating SCH fractures, and overall value of orthopaedic care may be improved by decreasing transfers for these common injuries. Level III-retrospective cohort study.
Identifiants
pubmed: 34545018
doi: 10.1097/BPO.0000000000001969
pii: 01241398-202201000-00005
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e8-e14Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Abzug JM, Herman MJ. Management of supracondylar humerus fractures in children: current concepts. J Am Acad Orthop Surg. 2012;20:69–77.
Holt JB, Glass NA, Bedard NA, et al. Emerging U.S. National Trends in the treatment of pediatric supracondylar humeral fractures. J Bone Joint Surg. 2017;99:681–687.
Kasser JR. Location of treatment of supracondylar fractures of the humerus in children. Clin Orthop Relat Res. 2005;434:110–113.
Vallila N, Sommarhem A, Paavola M, et al. Pediatric distal humeral fractures and complications of treatment in Finland. J Bone Joint Surg. 2015;97:494–499.
Farley FA, Patel P, Craig CL, et al. Pediatric supracondylar humerus fractures: treatment by type of orthopedic surgeon. J Child Orthop. 2008;2:91–95.
Ralles S, Murphy M, Bednar MS, et al. Surgical trends in the treatment of supracondylar humerus fractures in early career practice. J Pediatr Orthop. 2020;40:223–227.
Iobst CA, Stillwagon M, Ryan D, et al. Assessing quality and safety in pediatric supracondylar humerus fracture care. J Pediatr Orthop. 2017;37:e303–e307.
Wei DH, Hawker GA, Jevsevar DS, et al. Improving value in musculoskeletal care delivery: AOA Critical Issues. J Bone Joint Surg Am. 2015;97:769–774.
Porter ME. What is value in health care? N Engl J Med. 2010;363:2477–2481.
Gattu RK, De Fee AS, Lichenstein R, et al. Consideration of cost of care in pediatric emergency transfer—an opportunity for improvement. Pediatr Emerg Care. 2017;33:334–338.
Kumar V, Singh A. Fracture supracondylar humerus: a review. J Clin Diagn Res. 2016;10:RE01–RE06.
Guner S, Guven N, Karadas S, et al. Iatrogenic or fracture-related nerve injuries in supracondylar humerus fracture: is treatment necessary for nerve injury? Eur Rev Med Pharmacol Sci. 2013;17:815–819.
Shore BJ, Gillespie BT, Miller PE, et al. Recovery of motor nerve injuries associated with displaced, extension-type pediatric supracondylar humerus fractures. J Pediatr Orthop. 2019;39:e652–e656.
Wang SI, Kwon TY, Hwang HP, et al. Functional outcomes of Gartland III supracondylar humerus fractures with early neurovascular complications in children: a retrospective observational study. Medicine (Baltimore). 2017;96:e7148.
Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop. 2010;30:253–263.
Bashyal RK, Chu JY, Schoenecker PL, et al. Complications after pinning of supracondylar distal humerus fractures. J Pediatr Orthop. 2009;29:704–708.
Sankar WN, Hebela NM, Skaggs DL, et al. Loss of pin fixation in displaced supracondylar humeral fractures in children: causes and prevention. J Bone Joint Surg Am. 2007;89:713–717.
Brauer CA, Lee BM, Bae DS, et al. A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop. 2007;27:181–186.
Claireaux H, Goodall R, Hill J, et al. Multicentre collaborative cohort study of the use of Kirschner wires for the management of supracondylar fractures in children. Chin J Traumatol. 2019;22:249–254.
Joiner EA, Skaggs DL, Arkader A, et al. Iatrogenic nerve injuries in the treatment of supracondylar humerus fractures. J Pediatr Orthop. 2014;34:388–392.
Osateerakun P, Thara I, Limpaphayom N. Surgical treatment of pediatric supracondylar humerus fracture could be safely performed by general orthopedists. Musculoskelet Surg. 2018;103:199–206.
Dodds SD, Grey MA, Bohl DD, et al. Clinical and radiographic outcomes of supracondylar humerus fractures treated surgically by pediatric and non-pediatric orthopedic surgeons. J Childrens Orthop. 2015;9:45–53.
Skaggs DL, Cluck MW, Mostofi A, et al. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am. 2004;86:702–707.
Kocher MS, Kasser JR, Waters PM, et al. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial. J Bone Joint Surg Am. 2007;89:706–712.
Scannell BP, Jackson JB, Bray C, et al. The perfused, pulseless supracondylar humeral fracture: intermediate-term follow-up of vascular status and function. J Bone Joint Surg Am. 2013;95:1913–1919.
Pennock AT, Charles M, Moor M, et al. Potential causes of loss of reduction in supracondylar humerus fractures. J Pediatr Orthop. 2014;34:691–697.
Mehlman CT, Strub WM, Roy DR, et al. The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children. J Bone Joint Surg Am. 2001;83:323–327.
Skaggs DL, Sankar WN, Albrektson J, et al. How safe is the operative treatment of Gartland type 2 supracondylar humerus fractures in children? J Pediatr Orthop. 2008;28:139–141.
Aarons CE, Iobst C, Chan DB, et al. Repair of supracondylar humerus fractures in children: does pin spread matter? J Pediatr Orthop B. 2012;21:499–504.