Clinical Research Fails to Support More Aggressive Management of Pediatric Upper Extremity Fractures

Eismann, Emily A.; Little, Kevin J.; Kunkel, Samuel T.; Cornwall, Roger

doi:10.2106/jbjs.l.00764

Cited by 31 publications

(23 citation statements)

References 18 publications

(26 reference statements)

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“…A recent trend toward increasingly more operative management has been observed, despite the fact that, to our knowledge, there have been no long-term outcomes studies showing superior results following operative treatment [8][9][10][11]. Some authors even recommend the routine use of K-wires in cases where anatomical reduction cannot be achieved [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Think twice before re-manipulating distal metaphyseal forearm fractures in children

Roth

Denk

Colaris

et al. 2014

Arch Orthop Trauma Surg

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Re-manipulation of distal forearm fractures in children <12 years did not improve outcomes, deeming re-manipulations unnecessary. Children ≥12 years in the conservative group achieved satisfactory outcomes despite re-angulations exceeding current guidelines. Based on observed remodelling, we now accept up to 30° angulation in children <9 years; 25° angulation in children aged 9-<12; 20° angulation in children ≥12 years, when re-angulation occurs. We conclude that clinicians should be more reluctant to perform re-manipulations.

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Section: Introductionmentioning

confidence: 99%

Think twice before re-manipulating distal metaphyseal forearm fractures in children

Roth

Denk

Colaris

et al. 2014

Arch Orthop Trauma Surg

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“…The increasing trend of treating humeral shaft fractures by operative means is significant but not surprising finding; there are previous reports of increasing operative treatment of many childhood fractures (15,21,22). Surgical treatment of femoral shaft fractures has increased (23) but in particular upper extremity fractures such as forearm fractures (24), supracondylar (12) and proximal humeral fractures (18) have been treated more usually with surgery.…”

Section: Discussionmentioning

confidence: 99%

A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed

et al. 2020

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Introduction: Humeral shaft fractures have traditionally been treated non-operatively due to their good union and low rate of functional impairment. In the recent years, upper extremity fractures and their operative treatment have increased in children. Nevertheless, the trends of humeral shaft fractures are not clear. Materials and Methods: All children aged <16 years, with a humeral shaft fracture in the geographical catchment area of Northern Finland Hospital District, with a yearly child population-at-risk of ∼86 000 from the year 2001 until the end of 2015 were included. There were 88 cases, who comprised the study population. Radiographs were available of all. Injury, patient, and treatment characteristics were reviewed from hospital databases. Results: There was an increasing trend of surgical fixation of humeral shaft fractures during the 15 years' study period (β = 1.266, 95% CI 0.17 to 2.36, p = 0.035). However, we found no patient or fracture-related reasons that could have explained the increasing trend of surgical care. Comminuted fracture increased the risk of operative treatment 8-fold (Odds Ratio, OR 7.82, 95% CI 1.69 to 36.3, p = 0.009). Higher age, greater angular deformity or greater diameter of the humerus were not associated with the increased operation risk. Conclusions: The treatment philosophy concerning pediatric humeral shaft fractures has presented a shift from conservative care to surgical fixation. To authors' understanding there is not evidence supporting the increasing rate of osteosynthesis.

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“…37 Nevertheless, despite the trend against surgical fixation in childhood fractures, 18,40,42 the evidence supporting the superiority of surgical fixation of type II fractures is sparse. [43][44][45][46] The long-term outcomes of type II fractures seem not to differ according to nonoperative versus operative treatment, after satisfactory long (> 10 years) follow-up. 12 Therefore, as a conclusion, the increase of surgical fixation of type II fractures found in this study may not be completely supported by the current evidence and many type II fractures could still be treated nonoperatively.…”

Section: Discussionmentioning

confidence: 99%

Gartland Type II Supracondylar Humerus Fractures, Their Operative Treatment and Lateral Pinning Are Increasing: A Population-Based Epidemiologic Study of Extension-Type Supracondylar Humerus Fractures in Children

et al. 2016

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Supracondylar humerus fractures are usual in children but their recent trends are unclear. A population-based study was performed to determine the epidemiology of childhood supracondylar humerus fractures during the decade, 2000 to 2009, in a geographic area of Oulu, Finland. Altogether, 565 extension-type supracondylar humerus fractures were included. The fractures and their treatment were analyzed according to the Gartland classification. Fracture incidence increased by 28%, from 50.9 to 65.2 per 100,000 during 2000 to 2009 (β = 1.03, < 0.001). The increase was from 41.3 to 57.6 per 100,000 in girls (β = 1.9, < 0.001). Trampoline-related fractures in particular increased in girls. Type II fractures increased twofold from 7.1 to 16.3 per 100,000 (β = 1.1, < 0.001), whereas type I fractures decreased from 22.4 to 20.9 per 100,000 (β = -0.3, = 0.026).Surgical treatment increased during the 10 years study period from 32.6 to 51.8% ( = 0.022); it was in particular due to increase of operative care of type II fractures (from 5.9% in 2000-2001 to 37.1% in 2008-2009; = 0.011). Lateral pin fixation increased from nil to six (10.7%) ( < 0.001). The incidence and surgical stabilization of type II fractures in particular are increasing. There is a trend toward lateral pin fixation.

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Clinical Research Fails to Support More Aggressive Management of Pediatric Upper Extremity Fractures

Cited by 31 publications

References 18 publications

Think twice before re-manipulating distal metaphyseal forearm fractures in children

Think twice before re-manipulating distal metaphyseal forearm fractures in children

A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed

Gartland Type II Supracondylar Humerus Fractures, Their Operative Treatment and Lateral Pinning Are Increasing: A Population-Based Epidemiologic Study of Extension-Type Supracondylar Humerus Fractures in Children

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