Epidemiological Analysis of Displaced Supracondylar Fractures

Abstract

Introduction: Supracondylar fractures are one of the most common fracture patterns sustained by children, and one of the most common injuries requiring operative fixation. Understanding the complications associated with supracondylar fractures is vital for the practicing orthopedic surgeon. This analysis of supracondylar fractures examined the clinically important aspects including vascular injury, compartment syndrome, neurological injury, brachialis entrapment, associated injuries, and etiologies of injury. Recent advances in technology have resulted in a myriad of new forms of recreational equipment for children to play with. The purpose of this study is to compare the historical literature, the current literature, and a single surgeon's sample of supracondylar fractures. In addition, this study aims to evaluate if any changes in epidemiology or etiology have occurred due to the development of new recreational equipment. Objective: The purpose of this study is to evaluate and provide a qualitative overview of the epidemiology of displaced supracondylar fractures, to compare historically reported numbers to more recent literature as well as a single surgeon sample, and to evaluate if changes in epidemiology or etiology have occurred due to the new recreational equipment that children use. Methods: Some 75 displaced supracondylar elbow fractures were reviewed. Data elements recorded from the electronic medical record (EMR) included patient age, gender, height, weight, handedness, date, time, location, mechanism, Gartland classification, concurrent injuries, and neurovascular status. Results: In this study, there were 42 males and 33 females. The average age was six years. Some 70 of the 75 patients were older than the age three. One fracture was open, nine fractures had a pucker sign, seven presented with a nerve palsy, four presented without a pulse, and seven patients presented with an additional ipsilateral distal radius fracture. All fractures were the result of a fall. Falls from playground equipment resulted in 29 fractures. There were 10 from falls off of furniture, six from falls during sports, three from falls on the stairs, and three from fall off of bikes. The remaining fractures resulted from running, tripping, falling from a toy ball, sled, tree, wagon, fence, bounce house, van, deck, power wheels car, ATV, and a go-cart. Some 64 fractures were transferred from 27 different outside hospitals. Eleven fractures presented directly to the ED. Twenty-six fractures occurred during the summer, 20 occurred in the autumn, 6 occurred in the winter, and 23 occurred during the spring. Some 35 fractures occurred at home, 30 on the school grounds, four in a gymnasium, four in a park, one at a farm show, and one in a parking lot. Some 25 fractures were treated between midnight and 8 am, 16 were treated between 8 am and 5 pm, and 34 were treated between 5 pm and 1 2 3 4

Impact of the COVID-19 pandemic on the trauma and orthopaedic department at level one Major Trauma Centre in the republic of Ireland

“…likely explain this decline in paediatric fracture presentations. The most common reason for supracondylar fractures, which have fallen by 25% in this observational study, are falls from playground equipment and falls from a standing height (7,24).…”

COVID-19 pandemic restrictions unmasks dangers of frequent injury mechanisms for common surgically treated pediatric fractures

“…Product Safety Commission in the construction of monkey bars and building static monkey bars rather than mobile monkey bars, just as the organization did for the use of trampolines, leading to a general decrease in injuries from trampoline use. 6,14,15 Notably, this study had some limitations. Because of the retrospective nature of this study, it was not possible to directly interview patients to obtain a more accurate description of the injured child's activity and mechanism of injury.…”

Overview of the contemporary management of supracondylar humeral fractures in children

“…Supracondylar fractures of the distal humerus account for approximately 15% of all paediatric fractures [2][3][4]. The median age of presentation is six years [5][6][7][8], and the incidence gradually reduces with age until age 15, when patients tend to present with an adult pattern [8]. This injury is reported to be more common in males [5,8,9] but there is a lack of consensus, some reports indicating a higher incidence in females [10,11] and a recent evaluation of a cohort of > 63,000 children over a five year period did not demonstrate a statistically significant difference [7].…”