Are we staying up too late? Timing of surgery of displaced supracondylar fractures in children. Clinical audit in a paediatric tertiary UK trauma centre and literature review

Abdelmalek, Amir; Towner, Matthew; Clarke, Anna

doi:10.1007/s00402-021-04289-x

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…Instead, Yang et al using the same ethnic origin population as ours also confirmed that delayed treatment for 8 h to 5 days increased the ORIF rate [29]. Conversely, delayed treatment may not influence the risk of ORIF and emergency surgery at night is not recommended [31,32]. The delayed time to operation was defined as 36 h as many patients spend over 24 h when they came into the emergency room in developing countries, and additional hours for preoperative preparation should be considered.…”

Section: Discussionmentioning

confidence: 51%

Predictive factors for open reduction of flexion-type supracondylar fracture of humerus in children

Sun

Shan

Meng

et al. 2022

BMC Musculoskelet Disord

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Objective The incidence of open reduction and internal fixation (ORIF) in flexion-type supracondylar humerus fractures (SCHF) in children is significantly higher than that of extension-type fractures. This study aimed to identify risk factors for ORIF in flexion-type SCHF. Methods One hundred seventy-one patients with Wilkins type III flexion-type SCHF from January 2012 to December 2021 were retrospectively enrolled in a tertiary paediatric hospital. Patients were divided into ORIF group versus closed reduction and internal fixation (CRIF) group. Then, patients data of age, sex, injury side, obesity, deviation of displacement, fracture level, rotation, nerve injury, and delay from injury to surgery were reviewed. Univariate analysis and multivariate logistic regression were used to identify independent risk factors and odds ratios (OR) of ORIF. Results Overall, 171 children with type III flexion-type SCHF were analyzed (average aged 7.9 ± 2.8 years). Displacement was lateral in 151 cases, medial in 20. 20 cases had combined ulnar nerve injury. The failed closed reduction rate was 20%. Univariate analysis indicated age, distal fracture fragment rotation, and ulnar nerve injury were significantly associated with ORIF. (P = 0.047, P = 0.009, and P = 0.001, respectively). Multivariate logistic regression analysis showed that distal fracture fragment rotation (OR, 3.3; 95%CI:1.1–9.5; P = 0.028) and ulnar nerve injury (OR, 6.4; 95%CI:2.3–18.3; P = 0.001) were independent risk factors; however, the age was not an independent one (OR, 1.5; 95%CI:0.6–3.5; P = 0.397) for ORIF in the Wilkins type III flexion-type SCHF. Conclusion Distal fracture fragment malrotation on initial x-rays and ulnar nerve injury were significant risk factors for ORIF in Wilkins type III flexion-type SCHF. Surgeons should prepare tourniquets or other open reduction instruments when treating these types of fractures. Level of evidence Level IV

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Section: Discussionmentioning

confidence: 51%

Predictive factors for open reduction of flexion-type supracondylar fracture of humerus in children

Sun

Shan

Meng

et al. 2022

BMC Musculoskelet Disord

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“…At present, there is no consensus on a specific, standardized time threshold on early emergency surgeries of pediatric fractures in the literature. Most researchers set an early surgical time of 8 h, 12 h or 24 h [8,9,[18][19][20]]. If 12 h was taken as the standard time for early surgery in our study, less than 30% of the patients would have been eligible for the early surgery group.…”

Section: Discussionmentioning

confidence: 99%

Early versus delayed treatment of lateral condylar fracture of the humerus with > 2 mm displacement in children: a retrospective study

Wang

Gao

et al. 2023

J Orthop Surg Res

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Background The purpose of this study was to investigate the clinical and functional outcomes of early versus delayed treatment of pediatric lateral condylar fractures of the humerus with a displacement greater than 2 mm. Methods Sixty-seven children treated surgically at our hospital from March 2016 to September 2021 for lateral condylar fracture of the humerus with displacement > 2 mm were retrospectively analyzed. The children were divided into two groups where early surgery consisted of patients being operated on within 24-h post-injury (n = 36) and delayed surgery consisted of children operated after 24-h post-injury (n = 31). Clinical and functional results were compared between the two groups. Results There were no significant differences between the two groups in terms of operation time, blood loss and incidences of perioperative complications. However, mean length of incision was significantly greater (P < 0.0001) in the delayed treatment group (5.68 ± 1.08 cm) compared to the early treatment group (3.89 ± 0.82 cm). No differences were found in functional outcomes, consisting of the Baumann angle of the affected limb, the carrying angle, Mayo Elbow Performance Score, and Flynn’s criteria at final follow-up. Conclusions Delay in surgery for more than 24 h after injury does not influence the clinical and functional results for lateral condylar fracture of the humerus with displacement > 2 mm in children. However, delayed open reduction and pinning may increase the incision length possibly due to increased edema.

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Effectiveness of an early operating room start time in managing pediatric trauma

Kym¹,

Kaur²,

Pham³

et al. 2023

World J Orthop

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Shoulder pain is a common musculoskeletal complaint, and rotator cuff (RC) pathologies are one of the main causes. The RC undergoes various tendinopathic and avascular changes during the aging process. Other degenerative changes affecting its healing potential make it an appealing target for biological agents. Platelet-rich plasma (PRP) has demonstrated the potential to deliver a high concentration of several growth factors and anti-inflammatory mediators, and its clinical use is mainly supported by experiments that demonstrated its positive effect on muscle, ligaments, and tendinous cells. This review aimed to specify the role of PRP and its future applications in RC tendinopathies based on the current clinical evidence. Due to the different characteristics and conflicting outcomes, clinicians should use PRP with moderate expectations until more consistent evidence is available. However, it is reasonable to consider PRP in patients with contraindications to corticosteroid injections or those with risk factors for inadequate healing. Its autologous origin makes it a safe treatment, and its characteristics make it a promising option for treating RC tendinopathy, but the efficacy has yet to be established.

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Are we staying up too late? Timing of surgery of displaced supracondylar fractures in children. Clinical audit in a paediatric tertiary UK trauma centre and literature review

Cited by 3 publications

References 25 publications

Predictive factors for open reduction of flexion-type supracondylar fracture of humerus in children

Predictive factors for open reduction of flexion-type supracondylar fracture of humerus in children

Early versus delayed treatment of lateral condylar fracture of the humerus with > 2 mm displacement in children: a retrospective study

Effectiveness of an early operating room start time in managing pediatric trauma

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