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Samaila EM, Auregli L, Pezzè L, Colò G, Magnan B. Medium-term clinical results in the treatment of supracondylar humeral fractures in children: does the surgical approach impact outcomes? J Orthop Traumatol 2024; 25:43. [PMID: 39261419 PMCID: PMC11390990 DOI: 10.1186/s10195-024-00781-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/22/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Recent literature has found a consensus in favor of conservative treatment for type II supracondylar humeral fractures (SCHF). This retrospective observational study compares the short- to medium-term functional outcomes of conservative versus surgical treatment in 31 patients with SCHF (Gartland II and III) to assess the potential superiority of one approach over the other. MATERIALS AND METHODS Thirty-one pediatric patients treated for SCHF-19 classified as Gartland II and 12 as Gartland III-were assessed in our department. Eight patients underwent closed reduction and cast immobilization, 22 were treated with closed reduction and percutaneous pinning, and one underwent open reduction and internal fixation with plates. Clinical and functional data were collected during follow-up, including elbow and forearm range of motion (ROM), grip strength, carrying angle, Flynn's criteria, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS The average follow-up was 3.3 years (± 1.4 years). All patients demonstrated good functional recovery. According to Flynn's criteria, 85% and 81% of the patients achieved a satisfactory outcome in elbow flexion and carrying angle, respectively. No cases of nerve injuries were reported. Four patients developed cubitus varus in the Gartland II group, which was treated with closed reduction and casting with the initial alignment maintained (without a loss of reduction during the first week). However, compared to this group that was conservatively treated, functional and clinical outcomes were significantly better in the group with SCHF Gartland II treated with reduction and pinning (p < 0.05). CONCLUSIONS Although some recent studies have demonstrated positive outcomes with conservative treatment for both Gartland IIA and IIB fractures, the short- to medium-term functional results in our study emphasize that superior outcomes were obtained with surgical treatment for Gartland II fractures when compared to those treated conservatively. TRIAL REGISTRATION This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from our institute's ethics committee (registry no. 3511). LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
| | - Ludovica Auregli
- Department of Orthopaedics and Trauma Surgery, University of Verona, Verona, Italy
| | - Lorenzo Pezzè
- Department of Orthopaedics and Trauma Surgery, University of Verona, Verona, Italy
| | - Gabriele Colò
- Department of Orthopaedics and Trauma Surgery, Azienda Ospedaliera Universitaria Ss. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Bruno Magnan
- Department of Orthopaedics and Trauma Surgery, University of Verona, Verona, Italy
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Klahs KJ, Dertinger JE, Mello GT, Thapa K, Sandler AB, Garcia EJJ, Parnes N. Epidemiologic investigation of pediatric distal humerus fractures: An American insurance claims database study. World J Orthop 2024; 15:52-60. [PMID: 38293264 PMCID: PMC10824061 DOI: 10.5312/wjo.v15.i1.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types: Supracondylar (SC), lateral condyle (LC), and medial epicondyle (ME) fractures. AIM To evaluate the epidemiology of pediatric distal humerus fractures (SC, LC, and ME) from an American insurance claims database. METHODS A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC, LC and ME fractures based on the IBM Truven MarketScan® Commercial and IBM Truven MarketScan Medicare Supplemental databases. Patients from 2015 to 2020 were queried for treatments, patient age, sex, length of hospitalization, and comorbidities. RESULTS A total of 1133 SC, 154 LC, and 124 ME fractures were identified. SC fractures had the highest percentage of operation at 83%, followed by LC (78%) and ME fractures (41%). Male patients were, on average, older than female patients for both SC and ME fractures. CONCLUSION In the insurance claims databases used, SC fractures were the most reported, followed by LC fractures, and finally ME fractures. Age was identified to be a factor for how a pediatric distal humerus fractures, with patients with SC and LC fractures being younger than those with ME fractures. The peak age per injury per sex was similar to reported historic central tendencies, despite reported trends for younger physiologic development.
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Affiliation(s)
- Kyle Jay Klahs
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences-El Paso, El Paso, TX 79905, United States
| | - Jake E Dertinger
- Medical School, California Health Sciences University College of Osteopathic Medicine, Clovis, CA 93611, United States
| | - Grant T Mello
- Medical School, California Health Sciences University College of Osteopathic Medicine, Clovis, CA 93611, United States
| | - Kevin Thapa
- Undergraduate School, Binghampton University, Vestal, NY 13902, United States
| | - Alexis B Sandler
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences-El Paso, El Paso, TX 79905, United States
| | - E'Stephan J Jesus Garcia
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, TX 79918, United States
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, NY 13619, United States
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Kaya Ö, Gencer B, Çulcu A, Doğan Ö. Extra Lateral Pin or Less Radiation? A Comparison of Two Different Pin Configurations in the Treatment of Supracondylar Humerus Fracture. CHILDREN 2023; 10:children10030550. [PMID: 36980108 PMCID: PMC10047439 DOI: 10.3390/children10030550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
Background: Closed reduction and percutaneous fixation are the most commonly used methods in the surgical treatment of supracondylar humerus fractures. The pin configuration changes stability and is still controversial. The aim of this study was to investigate the relationship between surgical duration and radiation dose/duration for different pinning fixations. Methods: A total of 48 patients with Gartland type 2, 3, and 4 supracondylar fractures of the humerus were randomized into two groups—2 lateral and 1 medial (2L1M) pin fixation (n = 26) and 1 lateral 1 medial (1L1M) pin fixation (n = 22). A primary assessment was performed regarding surgical duration, radiation duration, and radiation dose. A secondary assessment included clinical outcome, passive range of motion, radiographic measurements, Flynn’s criteria, and complications. Results: There were 26 patients in the first group (2L1M) and 22 patients in the second group (1L1M). There was no statistical difference between the groups regarding age, sex, type of fracture, or Flynn’s criteria. The overall mean surgical duration with 1L1M fixation (30.59 ± 8.72) was statistically lower (p = 0.001) when compared to the 2L1M Kirschner wire K-wire fixation (40.61 ± 8.25). The mean radiation duration was 0.76 ± 0.33 s in the 1L1M K-wire fixation and 1.68 ± 0.55 s in the 2L1M K-wire fixation. The mean radiation dose of the 2L1M K-wire fixation (2.45 ± 1.15 mGy) was higher than that of the 1L1M K-wire fixation (0.55 ± 0.43 mGy) (p = 0.000). Conclusions: The current study shows that although there is no difference between the clinical and radiological outcomes, radiation dose exposure is significantly lower for the 1L1M fixation method.
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Affiliation(s)
- Özgür Kaya
- Department of Orthopedics and Traumatology, Faculty of Medicine, Lokman Hekim University, Ankara 06000, Turkey
- Correspondence:
| | - Batuhan Gencer
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara 06000, Turkey; (B.G.); (Ö.D.)
| | - Ahmet Çulcu
- Department of Orthopedics and Traumatology, Ministry of Health Yüksekova State Hospital, Hakkari 30110, Turkey;
| | - Özgür Doğan
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara 06000, Turkey; (B.G.); (Ö.D.)
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Schuller A, Hahn S, Pichler L, Hohensteiner A, Sator T, Jaindl M, Schwendenwein E, Tiefenboeck T, Payr S. Correlation of Fall Height, Fracture Severity and Clinical Outcome in Pediatric Supracondylar Fractures—A Retrospective Analysis with an Observation Period of 20 Years. CHILDREN 2023; 10:children10030510. [PMID: 36980068 PMCID: PMC10047500 DOI: 10.3390/children10030510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
The most common cause leading to supracondylar humerus fractures in children is falling onto an outstretched arm. A correlation between fall height and fracture severity may be assumed but has not yet been described. The aim of this study was to show that fracture severity increases with fall height. Furthermore, the correlation between fracture severity and outcome was examined. A total of 971 children with supracondylar humerus fractures between January 2000 and December 2019 were included in this study. The correlations between fall height and fracture severity and between fracture severity and outcome were assessed. Increasing fall height correlates with fracture severity (p < 0.001; r = 0.24). Furthermore, the incidence of complications increases with fracture severity and a correlation was present accordingly (p < 0.001; r = 0.28). A total of 30 (3.1%) patients showed limitations in range of motion and/or persistent neurologic deficits at the latest follow-up. Type I fractures rarely lead to subsequent limitations. The correlation between increasing fall height and fracture severity was significant. Furthermore, children with type III and IV supracondylar fractures are more likely to develop complications or restrictions in movement than children with type I and II fractures. Hence, the initial fall height may be an indirect indicator of a more or less favorable outcome.
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Sabaghzadeh A, Bonakdar S, Ebrahimpour A, Khoshkholghsima M, Gorji M, Soufiabadi K, Gholipour M. The Effect of COVID-19 Pandemic on the Characteristics of Pediatric Supracondylar Fracture: A Retrospective Cohort Study. Adv Biomed Res 2022; 11:100. [PMID: 36660758 PMCID: PMC9843589 DOI: 10.4103/abr.abr_49_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 01/21/2023] Open
Abstract
Background Environmental factors play a key role in the occurrence of pediatric supracondylar humerus (SH) fracture which has been widely affected by the COVID-19 pandemic and the measures taken to curb its spread. In this study, we aim to investigate the ultimate impact coronavirus pandemic has had on SH fractures in children. Materials and Methods This retrospective cohort study compares SH fractures which occurred during the pandemic with their prepandemic counterpart in a pediatric trauma public hospital. Patient's data, submitted from February to July 2020 and 2019, were collected and divided into two groups based on fractures' time of occurrence, i.e., during or before the pandemic. Results There was no significant difference in terms of gender, type of fracture, injury location, and time of admission during a day between the aforementioned groups. However, in the pandemic group, patients were transferred to the operating room significantly quicker (odds ratio; 2.13 vs. 0.607, P = 0.01) and the surgery duration was shorter (40.17 ± 12.28 min vs. 49.11 ± 15.48 min, P = 0.011). It was found that the location of injury (home, school, etc.) varied between the two groups (P = 0.01) and the proportion of domestic injuries during the pandemic grew significantly (53.6% vs. 19.8%). Conclusion Although the incidence of pediatric SH fractures has decreased due to the closure of schools and sports clubs during the pandemic, domestic occurrence of the same fracture type has grown disproportionately. To prevent this trend, pediatric centers should educate parents on child safety measures and fracture risks during the lockdown.
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Affiliation(s)
- Amir Sabaghzadeh
- Physiotherapy Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Clinical Research Development Unit, Akhtar Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sona Bonakdar
- Department of Foreign Languages, Urmia University, Urmia, Iran
| | - Adel Ebrahimpour
- Physiotherapy Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Clinical Research Development Unit, Akhtar Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Khoshkholghsima
- Clinical Research Development Unit, Akhtar Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Gorji
- Skin Reserch Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Kamand Soufiabadi
- Physiotherapy Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Clinical Research Development Unit, Akhtar Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Gholipour
- Physiotherapy Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Clinical Research Development Unit, Akhtar Shahid Beheshti University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Morteza Gholipour, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail:
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Toğaç S, Eken G, Ermutlu C, Sarisözen B. Forearm Compartment Pressure Change in Children Operated for Supracondylar Humerus Fracture. J Pediatr Orthop 2022; 42:509-515. [PMID: 35980756 DOI: 10.1097/bpo.0000000000002220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study is to examine the preoperative and postoperative forearm compartment pressures in patients treated operatively for Gartland type III extension type supracondyler humerus fractures and understand the course of these values over postoperative period. METHODS Deep volar compartment pressure of 31 patients were measured in the proximal one third of the forearm preoperatively, and measurements were continued every 4 hours for the first 24 hours after the operation with a catheter. Type of the reduction technique (open reduction vs. closed reduction), duration of surgery, the time from the injury to surgery were all evaluated. RESULTS In the measurements made immediately after the operation (0 h), a sudden increase in the compartment pressure was detected in all patients (15.0±5.9 to 27.9±7.5 mm Hg) independent of the reduction technique and gradually decreased over time. The mean compartment pressure at the 12th hour postoperatively was higher in the open reduction group than in the CR group (24.5±3.4, 20.7±6.7 mm Hg, respectively) ( P =0.044). The mean preoperative compartment pressure was 17.7±5.8 mm Hg in patients with a time from injury to surgery longer than 12 hours, and 12.4±4.8 mm Hg in patients with 12 hours or less ( P =0.006). The postoperative 0-, 12-, and 20-hour pressure values were higher in the >1 hour operation time group than in the ≤1 hour group and the differences were statistically significant ( P =0.046, 0.016, and 0.032, respectively). CONCLUSIONS In pediatric supracondylar humeral fractures, those who underwent open reduction had higher preoperative and postoperative compartment pressures. The reduction attempt was found to be a factor that increased the compartment pressure and after the operation, the compartment pressure values decrease gradually. Prolonged operative time (>1 h) and increased time from injury to operative fixation (>12 h) were associated with higher compartment pressures. LEVEL OF EVIDENCE Level II-prospective study.
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Affiliation(s)
- Soner Toğaç
- Department of Orthopedics and Traumatology, Manisa Merkezefendi State Hospital, Manisa
| | - Gökay Eken
- Department of Orthopedics and Traumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Cenk Ermutlu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Bartu Sarisözen
- Department of Orthopedics and Traumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
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Das R, Borthakur B, Agarwala V, Ghosh S. Evaluation of anterior approach in failed closed reduction and delayed presentation of supracondylar humerus fractures in children. J Orthop 2022; 30:51-58. [PMID: 35241888 PMCID: PMC8857543 DOI: 10.1016/j.jor.2022.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The treatment of displaced paediatric supracondylar fracture is a challenging problem and requires strict vigilance and a proper management protocol. Prospective investigation of the treatment options for fractures that cannot be reduced by closed reduction is recommended in literature. Operative treatment is indicated for the fractures that cannot be reduced satisfactorily by closed methods. It is also considered the best option for late presenting fractures. The aim of this study was to assess and compare the clinical outcome using open reduction through anterior approach in delayed presentation and failed closed reduction of supracondylar fracture humerus in children. MATERIALS AND METHODS 15 patients of failed closed reduction and 11 patients of delayed presentation of supracondylar humerus fractures were operated with anterior approach. The demographic data, time from injury to presentation and from admission to surgery, reasons for delayed presentation, type of fracture, operative findings and time, K-wire configuration, length of hospitalization, post operative complications were noted. The patients were followed up for a period of 12 months and final range of motion, Baumann's angle, and cosmetic, functional and overall outcome by Flynn's criteria were evaluated and analyzed. RESULTS The overall outcome was very satisfactory according to Flynn's criteria. 80.77% patients had excellent, 15.38% patients had good, and 3.85% patient had fair results with no poor results. Our results show distinct advantage of anterior approach which are on a par with or better than the previous studies using anterior approach, adding to their evidence. CONCLUSION Open reduction using anterior approach is a very safe, logical and effective technique of treating failed closed reduction or late presentation of supracondylar fractures humerus in children with excellent cosmetic and functional results, and offers distinctive advantage over other approaches.
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Affiliation(s)
- Rajdeep Das
- Department of Orthopaedics, Silchar Medical College & Hospital, Silchar, Assam, India
- Corresponding author.
| | - Bipul Borthakur
- Department of Orthopaedics, Silchar Medical College & Hospital, Silchar, Assam, India
| | - Vikash Agarwala
- Department of Orthopaedics, Silchar Medical College & Hospital, Silchar, Assam, India
| | - Shantasree Ghosh
- Department of Paediatrics, Silchar Medical College & Hospital, Silchar, Assam, India
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Liu S, Peng Y, Liu J, Ou Z, Wang Z, Rai S, Lin W, Tang X. Small incision reduction and external fixation for the treatment of delayed over fourteen days supracondylar humeral fractures in children. Front Pediatr 2022; 10:1039704. [PMID: 36405828 PMCID: PMC9668058 DOI: 10.3389/fped.2022.1039704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Supracondylar humeral fractures (SHF) are the most common type of fracture occurring at the distal humerus in children. In patients with delayed presentation of SHF, closed reduction is challenging to achieve with traditional reduction maneuvers. This study aimed to report the clinical results of pediatric SHF delayed over 14 days treated by closed reduction with a minimally invasive technique and external fixation and evaluate the efficacy of this technique. METHODS Between October 2010 and September 2018, children with delayed presentation of SHF over 14 days were retrospectively included in this study. The patients received closed reduction with a minimally invasive technique followed by external fixation. The demographics and radiographic data were collected. The Mayo Elbow Performance Score (MEPS) and the Flynn criteria were used to evaluate the clinical outcomes of treatments. RESULTS A total of 11 children (aged 4-13 years) with delayed presentation (range, 14-22 days) were recruited. They received surgery using closed reduction with a minimally invasive technique followed by external fixation. None of the surgery was done with the open method. After surgery, the patients' carrying angle returned to normal. The radiological union was evident in 8 to 12 weeks in all fractures without complications. Every patient had a good to excellent score on the MEPS and the Flynn criteria. CONCLUSIONS The results of this series indicated a satisfactory outcome in children with delayed more than 14 days of supracondylar humeral fractures. The closed reduction with a minimally invasive technique followed by external fixation is an alternative treatment for such injury.
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Affiliation(s)
- Shuai Liu
- Pediatric Orthopedics Department, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - YingYing Peng
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - JiaTong Liu
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ZiXuan Ou
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ZeZheng Wang
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, Karama Medical Center, Dubai, United Arab Emirates
| | - WeiFeng Lin
- Pediatric Orthopedics Department, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xin Tang
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ekwedigwe HC, Anyaehie UE, Ede O, Anikwe IA, Eyichukwu GO, Anieze JK. Predictors of early elbow function following paediatric humeral supracondylar fractures: A retrospective analysis. Niger J Clin Pract 2021; 24:1590-1595. [PMID: 34782495 DOI: 10.4103/njcp.njcp_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Supracondylar fracture usually occurs as a result of fall on an outstretched hand. Prompt management is essential to prevent complications. Functional outcome after management of this fracture may be predicted by some factors. Aims The study aimed to review the management of supracondylar fractures and determine what factors have an impact on the functional outcome of the elbow using MEPS score in the early post-operative period. Patients and Methods This study was a retrospective study of all patients with supracondylar fractures that presented at the accident and emergency department of a tertiary institution over a 2-year period. Their relevant data were retrieved from their folders and analysis done using SPSS 20. The MEPS score at 6 months was calculated. Multiple linear regressions were used to determine factors that can predict early elbow function using the MEPS score at 6 months. Results In the study, 61.4% (35) patients were males and 38.6% (22) females. The commonest mechanism of injury was fall on the outstretched hand (FOOSH), 70.2%. The mean duration of presentation to the hospital was 38 h (SD = 56.9). Among treatment offered to the patients, a higher number had open reduction with pinning. The mean postoperative Mayo elbow score was 87.6. Age of patients, Gartland type and the duration of cast immobilization were significant predictors of the MEPS at 6 months after treatment. Conclusion The Gartland type and duration of cast immobilization are the most important predictors of the MEPS score at 6 months in this study.
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Affiliation(s)
- H C Ekwedigwe
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - U E Anyaehie
- Department of Orthopaedic Surgery, National OrthopaedicHospital, Thinkers Corner, Enugu, Nigeria
| | - O Ede
- Department of Orthopaedic Surgery, National OrthopaedicHospital, Thinkers Corner, Enugu, Nigeria
| | - I A Anikwe
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - G O Eyichukwu
- Department of Orthopaedic Surgery, National OrthopaedicHospital, Thinkers Corner, Enugu, Nigeria
| | - J K Anieze
- Department Plastic and Reconstructive Surgery, National Orthopaedic Hospital, Thinkers Corner, Enugu, Nigeria
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10
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Aspects of Epidemiology and Treatment of Supracondylar Fractures of the Humerus in Children in South-Eastern Romania. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2021-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
Supracondylar fractures are frequently encountered in childre and have a high prevalence of associated complications. Supracondylar fractures, due to their frequency, aspect and the serious health problems that can result, require a rapid and precise intervention, based on a well-defined evaluation methodology
In this paper, we assess the epidemiology and the management of supracondylar fractures treated within the Surgery and Pediatric Orthopedics Clinic of the Emergency County Hospital of Constanta.
We conducted a retrospective study on 222 pediatric patients with supracondylar fractures of the humerus during between 2019 and 2021 treated in County Clinical Emergency Hospital of Constanta. The data was collected from the medical records of the patients recorded on the Clinic of Pediatric Surgery and Pediatric Orthopedics.
We obtained a higher percentage of males with fractures (60%). Falling from the same level was the main cause of fracture, followed at close distance by fall from different level, other causes, among which car accidents being observed less in our study.
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Bergman E, Lempesis V, Nilsson JÅ, Jephsson L, Rosengren BE, Karlsson MK. Time trends in pediatric fractures in a Swedish city from 1950 to 2016. Acta Orthop 2020; 91:598-604. [PMID: 32589095 PMCID: PMC8023972 DOI: 10.1080/17453674.2020.1783484] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - As previous studies indicate time trends in pediatric fracture incidence, we followed the incidence in a Swedish city between 1950 and 2016.Patients and methods - Malmö city, Sweden had 322,574 inhabitants in 2015. We used diagnosis registry, charts, and radiographs of the only city hospital to classify fractures in individuals < 16 years in 2014-2016, and compared these with data from 1950-2006. We used joinpoint regression to analyze time trends and present results as mean annual percentage changes (APC). Differences between periods are described as incident rate ratios (IRR). To describe uncertainty, 95% confidence intervals (CI) are used.Results - During 2014-2016 the pediatric fracture incidence was 1,786 per 105 person-years (boys 2,135 and girls 1,423). From 1950 onwards age-adjusted fracture incidence increased until 1979 in both boys (APC +1.5%, CI 1.2-1.8) and girls (APC +1.6%, CI 0.8-2.5). The incidence remained stable from 1979 to 2016 (APC in boys 0.0%, CI -0.3 to 0.3 and in girls -0.2%, CI -1.1 to 0.7). Age-adjusted incidence 2014-2016 was higher than 2005-2006 in girls (IRR 1.1, CI 1.03-1.3), but not in boys (IRR 1.0, CI 0.9-1.1).Interpretation - Fracture incidence was in girls higher in 2014-2016 than in 2005-2006. However, only with more than 2 measuring points are meaningful trend analyses possible. When we analyzed the period 1950-2016 with 17 measuring points and joinpoint regression, we found that fracture incidence increased in both sexes until 1979 but has thereafter been stable.
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Affiliation(s)
- Erika Bergman
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden,Correspondence:
| | - Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jan-Åke Nilsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Lars Jephsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
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Ausó-Pérez JR, Rodríguez-Blanes GM. Comprehensive Analysis of Pediatric Supracondylar Fractures in the Emergency Department; A Single Center Experience. Bull Emerg Trauma 2020; 8:142-147. [PMID: 32944573 PMCID: PMC7468217 DOI: 10.30476/beat.2020.83195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To describe the demographic characteristics and to assess possible risk factors related to the moment of presentation at Emergency Department (ED) for pediatric humeral supracondylar fractures. Methods: This was cross-sectional study being conducted during 5-year period from 2013 to 2017 at ED of a regional hospital in Spain. We have included all the pediatric patients (<14 years) with supracondylar fractures referring to our center during the study period. The demographic, clinical and radiological characteristics of the patients were recorded. The outcome and treatment strategies were also recorded. The risk factors of the pediatric supracondylar fracture was also assessed in our series. Results: We have included 52 pediatric patients with supracondylar fractures in this series. The mean age was 7.48 ± 2.97 years with a minimum age of 2 years and a maximum of 14 years. Among the patients there were 32 (61.54%) male and 20 (38.46%) female. Age less than 7 years found to be a protective factor against unstable fractures [OR 0.33 (0.10 - 1.02)]. Fractures presented during daytime hours showed a greater instability [OR 3.49 (1.07-11.39)]. However, the risk of presentation at nighttime was higher during the summer months (June to September). Conclusion: The older is the child, the greater is the risk of suffering an unstable fracture, which increases the need for surgery. This risk is greater during the daytime. Otherwise, during the summer months, there is a higher risk of patient presentation at nighttime.
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Affiliation(s)
- José Ramón Ausó-Pérez
- Orthopedic Surgery and Traumatology Services, Hospital Marina Baixa, Alicante, Spain
| | - Gloria María Rodríguez-Blanes
- Occupational Health Unit, Public Health Center of Alcoy, Alicante; Conselleria of Universal Health and Public Health, Generalitat Valenciana, Spain
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Challa S, Agarwal-Harding KJ, Levy P, Barr-Walker J, Sabatini CS. Supracondylar humerus fractures in low- and lower middle-income countries: a scoping review of the current epidemiology, treatment modalities, and outcomes. INTERNATIONAL ORTHOPAEDICS 2020; 44:2443-2448. [PMID: 32691122 DOI: 10.1007/s00264-020-04694-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this scoping review was to examine the nature and quality of research regarding paediatric supracondylar humerus (SCH) fractures in low and lower middle-income countries (LICs). METHODS We searched PubMed, Embase, Web of Science, and African Journals Online on January 9, 2018, for studies of SCH fractures in LICs. Studies were categorized by geographic region, Gartland classification of included patients, and study design. We evaluated each study's methodology and conclusions. RESULTS Out of 1805 results, we analyzed 105 studies, most of which included type 3 fractures only (66%). Many were conducted in South Asia (58%) and assessed treatment outcomes (78%). Most of the studies had level IV evidence (67%). Common limitations of research were small sample size (12%) and inadequate follow-up (6%). Epidemiological studies concluded that SCH fractures are more common among male children, are usually secondary to falls, and rarely present with nerve injuries. Most therapeutic studies reported outcomes of surgery (91%). Thirteen studies concluded that all-lateral versus cross-pinning techniques have similar outcomes. Seven studies reported preference for closed reduction over open reduction, when intra-operative fluoroscopy was available. Most common outcome measures were Flynn criteria (77%) and range of motion (53%). None of the papers looked at treatment costs. CONCLUSIONS Our data show a predominance of small level IV studies from LICs, with few studies of higher level of evidence. Many studies examined controversies with surgical technique, similar to studies performed in high-income countries. Few studies examined non-operative treatment, which is commonly the predominant treatment available for patients in LICs. Further investigation of common treatment modalities and outcomes for SCH fractures in LICs is needed.
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Affiliation(s)
- Sravya Challa
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA.
- UCSF Department of Orthopedic Surgery, Institute for Global Orthopaedics and Traumatology, San Francisco, CA, USA.
| | - Kiran J Agarwal-Harding
- Harvard Global Orthopaedics Collaborative, Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
- Department of Orthopaedic Surgery, The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA
| | - Paul Levy
- UCSF Department of Orthopedic Surgery, Institute for Global Orthopaedics and Traumatology, San Francisco, CA, USA
| | - Jill Barr-Walker
- Zuckerberg San Francisco General Library, University of California, San Francisco, San Francisco, CA, USA
| | - Coleen S Sabatini
- UCSF Department of Orthopedic Surgery, Institute for Global Orthopaedics and Traumatology, San Francisco, CA, USA
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
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Abstract
Supracondylar humerus (SCH) fractures are reported to be approximately twice as common among boys as among girls. Little is known about sex-associated differences in fracture patterns and complications. We compared the incidence of pediatric SCH fractures, injury mechanism (high-energy or low-energy), fracture subtypes, associated neurologic injuries, and treatment types by patient sex.We reviewed 1231 pediatric SCH fractures treated at 1 center from 2008 to 2017, analyzing sex distributions overall and by year and fracture subtype. We noted patient demographic characteristics, injury mechanisms, neurologic injuries, and treatments (nonoperative or operative). Binomial 2-tailed, chi-squared, and Student's t tests were used for analysis. Multiple logistic regression was performed to assess associations between sex, age, and injury mechanism. Alpha = 0.05.We found no significant difference in the distribution of girls (52%) vs boys (48%) in our sample compared with a binomial distribution (P = .11). Annual percentages of fractures occurring in girls ranged from 46% to 63%, and sex distribution did not change significantly over time. The mean (± standard deviation) age at injury was significantly younger for girls (5.5 ± 2.5 years) than for boys (6.1 ± 2.5 years) (P < .001). High-energy injury mechanism was associated with older age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.06) but not male sex (OR, 1.04; 95% CI, 0.98-1.1). The overall incidence of neurologic injury was 9.5% but boys did not have greater odds of sustaining neurologic injury (OR, 1.03; 95% CI, 1.0-1.1). We found no sex-associated differences in the distribution of Gartland fracture subtypes (P = .13) or treatment type (P = .39).Compared with boys, girls sustain SCH fractures at a younger age. SCH fractures were distributed equally among girls and boys in our sample. Patient sex was not associated with fracture subtype, injury mechanism, neurologic injury, or operative treatment. These findings challenge the perception that SCH fracture is more common in boys than girls.Level III, retrospective study.
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