1
|
Wang Y, Chong Q, Zhang S, Ben Y, Li Q, Chen D, Zheng P. Analysis of risk factors for failed closed reduction in pediatric Gartland Type III supracondylar humerus fracture. J Shoulder Elbow Surg 2024:S1058-2746(24)00409-9. [PMID: 38852708 DOI: 10.1016/j.jse.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Gartland Type III supracondylar humerus fractures (SCHFs) are commonly treated using closed reduction followed by percutaneous pin fixation. However, conversion to open reduction may be necessary if closed reduction fails. This study aimed to identify risk factors associated with failed closed reduction and provide a theoretical basis for clinical decision-making in the treatment of Gartland Type III fractures. METHODS A retrospective analysis was conducted on children with Gartland Type III SCHF who underwent surgical treatment between April 2017 and June 2018. Based on whether or not the closed reduction was successful, patients were split into the open reduction group and the closed reduction group. Within the closed reduction group, subgroup analysis based on surgery duration was carried out. Data were collected from medical records and X-ray images. Univariate and multivariate regression analyses were utilized to evaluate the relationship between variables and failed closed reduction. RESULTS The study included 36 patients in the open reduction group and 135 patients in the closed reduction group. Multivariate analysis revealed that the presence of angle (P = .024, OR = 3.199), rotation (P = .000, OR = 6.359), skin creases (P = .013, OR = 4.077), anterior-posterior displacement ratio (P = .011, OR = 4.337), fracture angle in the anteroposterior view (P = .014, OR = 0.939), and fracture distal displacement direction (P = .002, OR = 5.384) were independent risk factors for failed closed reduction. Subgroup analysis showed that fracture distal displacement direction (P = .013), skin folds (P = .013), lateral displacement ratio (P = .016), and anterior-posterior displacement value (P = .005) significantly influenced the duration of closed reduction surgery. CONCLUSION The presence of sharp angle or rotation at the fracture ends, skin folds on the anterior elbow, minor anterior-posterior displacement of the fracture, higher medial inclination of the fracture plane, and distal fracture displacement toward the radial side are independent risk factors for failed closed reduction in pediatric Gartland Type III SCHF.
Collapse
Affiliation(s)
- Yiwei Wang
- Department of Orthopedics surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, Republic of China
| | - Qingqing Chong
- Department of Orthopedics surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, Republic of China
| | - Shengnan Zhang
- Department of Orthopedics surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, Republic of China
| | - Yulong Ben
- Department of Orthopedics surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, Republic of China
| | - Qiang Li
- Department of Orthopedics surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, Republic of China
| | - Dan Chen
- Department of Orthopedics surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, Republic of China.
| | - Pengfei Zheng
- Department of Orthopedics surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, Republic of China.
| |
Collapse
|
2
|
Seo KB, Kim BS, Park YG, Lim C. Associated Factor and Long-Term Clinical Outcomes for Patients with Postoperative Rotational Malreduction in Pediatric Supracondylar Humeral Fractures. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:791. [PMID: 38792974 PMCID: PMC11123191 DOI: 10.3390/medicina60050791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 04/27/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Long-term outcomes of immediately postoperative rotational malreduction in the axial plane after operative treatment of supracondylar humeral fractures (SCHF) are unknown. This study aimed to investigate the long-term clinical outcomes and associated factors for immediately postoperative rotational malreduction of SCHF. Materials and methods: In this retrospective case-control study, 88 patients who underwent surgery for Gratland type III SCHF were enrolled between January 2012 and January 2020. Among them, 49 patients had immediately postoperative malrotational reduction (rotational malreduction group) and 39 patients had no rotational deformity (control group). To evaluate the associated factors for immediately postoperative rotational malreduction, demographic data, fracture patterns, physical examination signs, and preoperative radiological parameters were analyzed. To compare the clinical outcomes, operation time, range of motion of the elbow, time from operation to full range of motion, and Flynn criteria were evaluated. The Oxford elbow score was used to investigate long-term clinical outcomes for patients five years after operation. Results: The mean age was 5.7 ± 2.3 years and mean follow-up period was 15.7 ± 4.0 months. The rotational malreduction group had significantly more patients with oblique fracture pattern (p = 0.031) and Pucker sign (p = 0.016) and showed a significantly longer operative time (p = 0.029) than the control group. Although there was no significant difference in the range of elbow motion and the Flynn criteria, the Kaplan-Meier survival curve showed a longer time to recover the full range of elbow motion in the rotational malreduction group (p = 0.040). There were no significant differences in the long-term clinical outcomes assessed using the Oxford elbow score (p = 0.684). Conclusions: Oblique fracture pattern and Pucker sign may be associated with immediately postoperative rotational malreduction in the axial plane. Although patients with immediately postoperative rotational malreduction showed favorable results of long-term clinical outcomes, they required more weeks to recover the full range of elbow motion.
Collapse
Affiliation(s)
| | | | | | - Chaemoon Lim
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju 63241, Republic of Korea; (K.B.S.); (B.S.K.); (Y.-G.P.)
| |
Collapse
|
3
|
Wang Q, Wang Y, He M, Cao H, Zhao J. Research: Construction and validation of elbow function prediction model after supracondylar humerus fracture in children. Medicine (Baltimore) 2023; 102:e36775. [PMID: 38206691 PMCID: PMC10754596 DOI: 10.1097/md.0000000000036775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/04/2023] [Indexed: 01/13/2024] Open
Abstract
This article's objectives are to develop a model to predict children's recovery of elbow function following supracondylar fracture, analyze the risk factors affecting those children's elbow function after surgery, and propose a individualized treatment strategy for elbow function in various children. We retrospectively analyzed clinical data from 410 children with supracondylar humerus fracture. A modeling set and a validation set of kids in the included studies were arbitrarily split into 2 groups on a 7:3 basis. To identify statistically significant risk factors, univariate logistic regression analysis was used. Then, multivariate logistic regression was used with the risk factors, and the best logistic regression model was chosen based on sensitivity and accuracy to create a nomogram; A total of 410 children were included in the study according to the inclusion criteria. Among them, there were 248 males and 162 females, and the fracture type: 147 cases of type IIb and 263 cases of type III. There were no significant changes in the afflicted limb's lateral difference, surgical method, onset season, and number of K-wires, according to univariate logistic regression analysis. Age (P < .001), weight (P < .001), height (P < .001), preoperative elbow soft tissue injury (OR = 1.724, 95% CI: 1.040-2.859, P = .035), sex (OR = 2.220, 95% CI: 1.299-3.794, P = .004), fracture classification (Gartland IIb) (OR = 0.252, 95% CI: 0.149-0.426, P < .001), no nerve injury before surgery (OR = 0.304, 95% CI: 0.155-0.596, P = .001), prying technique (OR = 0.464, 95% CI: 0.234-0.920, P = .028), postoperative daily light time > 2 hours (OR = 0.488, 95% CI: 0.249-0.955, P = .036) has a significant difference in univariate analysis; Multivariate regression analysis yielded independent risk factors: fracture classification; No nerve injury before surgery; The daily light duration after surgery was > 2 hours; soft tissue injury; Age, postoperative cast fixation time. The establishment of predictive model is of significance for pediatric orthopedic clinicians in the daily diagnosis and treatment of supracondylar humerus fracture.
Collapse
Affiliation(s)
- Qian Wang
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, P. R. China
| | - Yu Wang
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, P. R. China
| | - Man He
- Department of Rehabilitation, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, P. R. China
| | - Haiying Cao
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, P. R. China
| | - Jingxin Zhao
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, P. R. China
| |
Collapse
|
4
|
Ma HL, Sun XW, Liu F, Hua ZT, Sun J, Zhang SC. Kirschner wire reconstruction of medial and lateral column periosteal hinge in the treatment of multidirectionally unstable supracondylar fracture of the humerus in children. Eur J Med Res 2023; 28:585. [PMID: 38082369 PMCID: PMC10714489 DOI: 10.1186/s40001-023-01560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
AIM AND OBJECTIVE To compare the clinical effect of reconstruction of internal and lateral column periosteal hinge-assisted treatment with Kirschner wire and internal fixation with Kirschner wire in the treatment of multidirectional unstable supracondylar fractures of humerus in children. METHODS A retrospective cohort study was conducted to analyze the clinical data of 48 patients (31 male, 17 female; mean age: 6.7 ± 2.4 years old) with multidirectionally unstable supracondylar fractures of the humerus treated in our Hospital from August 2020 to August 2022. Twenty-five cases were treated with Kirschner wire reconstruction of the internal and lateral column periosteal hinge assisted by closed reduction and Kirschner wire internal fixation (study group). Twenty-three cases were treated with closed reduction and Kirschner wire internal fixation (control group). The operation time, intraoperative fluoroscopy times, percentage of patients who underwent open reduction after failure of closed reduction, fracture healing time, Baumann angle (BA), shaft-condylar angle (SCA), range of motion (ROM), and Flynn score of elbow at the last follow-up were compared between two groups. Complications such as infection and irritation of Kirschner wire tail were observed in two groups 2 months after the operation. RESULTS All patients were followed up for 10-22 months ([13.85 ± 2.89] months). The average operation time of the control group was 82.1 min, which was significantly longer than that of the study group 32.3 min (P < 0.05). The number of intraoperative fluoroscopy (29.4 ± 9.2) in the control group was significantly higher than that in the study group (15.2 ± 6.3) (P < 0.05). The incision rate of the control group was 17% while that of the study group was 0 (P < 0.05). According to Flynn score, the excellent and good rate of the elbow joint in the control group was 86.9% (20/23). The excellent and good rate of the elbow joint in the study group was 92.0% (23/25) (P > 0.05). There was no significant difference in fracture healing time, BA, SCA, and ROM between the two groups (P > 0.05). No infection or Kirschner wire tail irritation occurred in the two groups during the 2-month follow-up. CONCLUSION Reconstruction of internal and lateral periosteal hinges with Kirscher wire has similar effects to closed reduction and Kirschner wire fixation in the treatment of multidirectionally unstable supracondylar fractures of the humerus in children, but it can shorten the operation time and reduce intraoperative fluoroscopy times and incision rate.
Collapse
Affiliation(s)
- Hai-Long Ma
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Xi-Wei Sun
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Fang Liu
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Zhong Tuo Hua
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Jun Sun
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Si-Cheng Zhang
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China.
| |
Collapse
|
5
|
Garcia-Rueda MF, Mendoza-Pulido C, Taborda-Aitken JC, Becerra G, Velasquez-Urrego JL, Rincón-Lozano JD, Caicedo-Gutierrez ML, Silva-Amaro AC, Lorza-Toquica LD, Rodriguez-Lopez JA, Salazar-Sierra JA, Saravia-Hoyos GA, Schuster-Wasserman JA, Valencia-Chamorro MP. Distribution of fractured bones among children: Experience with the Comprehensive Pediatric AO classification in a children's orthopedic hospital in Bogotá-Colombia. Injury 2023; 54 Suppl 6:110780. [PMID: 38143128 DOI: 10.1016/j.injury.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Fractures in children and adolescents are a public health issue. However, reliable epidemiological descriptions of the South American population must be improved. This study aims to present epidemiological data on fractures from a children's orthopedic hospital in one of the five largest cities in Latin America. PATIENTS AND METHODS Descriptive epidemiological data from 2015 to 2019 were used to characterize children's fractures. Demographic variables, the number of fractured bones, high-energy trauma findings, fracture characteristics, fingertip injuries, and associated complications discriminated by the type of treatment are presented. Long bone fractures were classified according to the AO classification. All children less than 18 years of age were included. RESULTS In a population of 3,616 children, 4,596 fractures were identified. More boys than girls sustain a fractured bone, with ratios as high as 6:1 around 15 years old. Distal forearm fractures were the most common (31.9%), followed by distal humerus (20.2%). Most of the complications were related to these two sites of fractures. The OR of complications between surgical and conservative management was 2.86. CONCLUSION Epidemiological data of fractures from the authors' institution display the usual trending reported in most populations. Gender-related and age-related differences were relevant. Most fractures and complications are related to upper limb low-energy trauma. The most frequent are loss of ROM and loss of reduction. LEVEL OF EVIDENCE Level III - retrospective cohort study.
Collapse
Affiliation(s)
| | - Camilo Mendoza-Pulido
- School of Medicine, Department of Physical Medicine and Rehabilitation, Universidad Nacional de Colombia, Carrera 45 #26-85, Bogotá, Colombia
| | - Juan Carlos Taborda-Aitken
- School of Medicine, Department Orthopedics and Traumatology, Universidad Javeriana, Carrera 7 #40-62, Bogotá, Colombia
| | - Gustavo Becerra
- School of Medicine, Universidad Militar Nueva Granada, Carrera 11 #101-80 Bogotá, Colombia
| | | | - Julián David Rincón-Lozano
- Department of Orthopedics and Traumatology, Instituto Roosevelt, Carrera 4 east #17-50, Bogotá, Colombia
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Wu X, Lin R, Chen J, Chen S. Closed reduction with percutaneous Kirschner wire drill-and-pry for pediatric supracondylar humeral fractures with bony callus formation and delayed presentation. Injury 2023; 54:547-551. [PMID: 36529549 DOI: 10.1016/j.injury.2022.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Supracondylar humeral fractures are the most common type of pediatric elbow fractures, and are primarily treated using closed reduction and percutaneous pinning. For patients who are treated ≥14 days after the injury, after callus formation has occurred, closed reduction is usually not possible. The purpose of this study is to report the clinical outcomes of closed reduction with percutaneous Kirschner wire (K-wire) drill-and-pry for the delayed treatment of pediatric supracondylar humeral fractures with bony callus formation. METHODS We retrospectively reviewed the data of 16 patients who underwent percutaneous K-wire drill-and-pry between November 2019 and August 2021 for the treatment of supracondylar humeral fractures with bony callus formation ≥14 days after the injury. Clinical outcomes were assessed using the Flynn criteria. The postoperative Baumann angle and pin configuration were evaluated using x-ray examinations. RESULTS All patients were followed up for 8-28 months (average, 16.63 months). The fractures healed in 4-6 weeks (average, 4.38 weeks). The operative time ranged from 10 to 124 min (average, 35.12 min). No iatrogenic vascular or nerve injury occurred. No patient developed cubitus varus. According to the Flynn criteria, 12 patients had excellent outcomes, 2 patients had good outcomes, 1 patient had a fair outcome and 1 patient had a poor outcome. CONCLUSION Closed reduction with percutaneous K-wire drill-and-pry is a mini invasive technique for supracondylar humeral fractures with bony callus formation in children. Most patients had a good clinical and cosmetic outcomes without scarring.
Collapse
Affiliation(s)
- Xinwu Wu
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China; Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou 350007, China; Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Ran Lin
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China
| | - Jinchen Chen
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China
| | - Shunyou Chen
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China; Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou 350007, China; Fuzhou Trauma Medical Center, Fuzhou 350007, China.
| |
Collapse
|
7
|
Kow RY, Low CL, Awang MS. Supracondylar Humerus Fractures in Infants and Toddlers: An Unexplored Area. J INVEST SURG 2023; 36:1-2. [DOI: 10.1080/08941939.2022.2136803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R. Y. Kow
- Department of Orthopaedics, Traumatology & Rehabilitation, Sultan Ahmad Shah Medical Centre @IIUM, International Islamic University Malaysia, Kuantan, Malaysia
| | - C. L. Low
- Department of Radiology, Sultan Ahmad Shah Medical Centre @IIUM (SASMEC @IIUM), Kuantan, Malaysia
| | - M. S. Awang
- Department of Orthopaedics, Traumatology & Rehabilitation, Sultan Ahmad Shah Medical Centre @IIUM, International Islamic University Malaysia, Kuantan, Malaysia
| |
Collapse
|
8
|
Greve F, Müller M, Wurm M, Biberthaler P, Singer G, Till H, Wegmann H. Standalone Axial Malrotation after Pediatric Supracondylar Fracture Does Not Seem to Be an Indication for Immediate Postoperative Revision Surgery. CHILDREN 2022; 9:children9071013. [PMID: 35883997 PMCID: PMC9322951 DOI: 10.3390/children9071013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Rotational spurs as evidence for post-surgical malrotation are frequently observed when treating pediatric supracondylar humeral fractures (SCHFs). This study aimed to investigate the long-term outcome of a pediatric cohort with unrevised axial malrotation and to discuss the indication for revision surgery. Postoperative radiographs of children treated for SCHFs over eight years were retrospectively analyzed. Children with radiological signs of malrotation (von Laer malrotation quotient) were invited for a follow-up clinical and radiological examination. Among 338 treated children, 39 (11.5%) with a mean age of 5.3 years (range 1.8–11.7 years) showed radiological signs for postoperative malrotation and were not revised and therefore invited to participate in the study. Twelve patients (31%) with a mean age of 11.3 years (range 8.8–13.8 years) took part in the follow-up examination after a mean of 7.1 years (range 5.4 to 11.3 years). The mean postoperative van Laer malrotation quotient was 0.15 (range 0.11–0.2). At follow-up, the range of motion of the elbow joint was not significantly different compared to the contralateral side. Apart from the humeral ulnar angle (p = 0.023), there were no significant differences in the radiological axes. The Flynn criteria were excellent and good in 90% of the cases. The mean was 1.7 points indicating excellent subjective results. Standalone postoperative malrotation did not lead to an adverse long-term outcome in a small cohort of pediatric patients with SCHFs and did not indicate immediate postoperative revision surgery. However, further investigations with larger cohorts should verify whether additional criteria such as stability of the osteosynthesis and signs for increasing valgus or varus displacement in the follow-up radiographs should get more importance in decision making.
Collapse
Affiliation(s)
- Frederik Greve
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
- Correspondence: ; Tel.: +49-89-41402126
| | - Michael Müller
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
| | - Georg Singer
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, 8063 Graz, Austria; (G.S.); (H.T.)
| | - Holger Till
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, 8063 Graz, Austria; (G.S.); (H.T.)
| | - Helmut Wegmann
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
| |
Collapse
|
9
|
Buget MI, Canbolat N, Chousein CM, Kizilkurt T, Ersen A, Koltka K. Comparison of nighttime and daytime operation on outcomes of supracondylar humeral fractures: A prospective observational study. Medicine (Baltimore) 2022; 101:e29382. [PMID: 35801799 PMCID: PMC9259128 DOI: 10.1097/md.0000000000029382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Supracondylar humeral fractures are seen in children and treatment is usually closed reduction and percutaneous pinning (CRPP). This surgery can be performed at night, depending on its urgency. Fatigue and sleep deprivation can impact performance of doctors during night shifts. The purpose of this study is to investigate the association between night shifts postoperative morbidity and mortality of supracondylar fracture operations compared to daytime procedures. This prospective observational study included 94 patients who were aged 5 to 12 years with ASA I to III who had supracondylar humeral fractures, underwent CRPP under general anesthesia. Patients were stratified by the time of surgery using time of induction of anesthesia as the starting time of the procedure, into 2 groups: day (07:30 am-06:29 pm) and night (06:30 pm-07:29 am). In total, 82 patients completed the study: 43 in Group Day and 39 in Group Night. The operation duration in Group Night (114.66 ± 29.46 minutes) was significantly longer than in Group Day (84.32 ± 25.9 minutes) (P = .0001). Operation duration (OR: 0.007; P = .0001) and morbidities (OR: 0.417; P = .035) were independent risk factors in Group Night. Children who had supracondylar humeral fractures, undergoing urgent CRPP surgery, in-hospital mortality was associated with the time of day at which the procedure was performed. Patient safety is critically important for pediatric traumatic patient population. Therefore, we suggested to increase the number of healthcare workers and improve the education and experience of young doctors during night shifts.
Collapse
Affiliation(s)
- Mehmet I. Buget
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nur Canbolat
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- * Correspondence: Nur Canbolat, MD, Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Turgut Ozal Millet Cd, 34093, Istanbul, Turkey (e-mail: )
| | - Chasan M. Chousein
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Taha Kizilkurt
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Ersen
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kemalettin Koltka
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|