Extension Type II Pediatric Supracondylar Humerus Fractures

Camus, Tristan; MacLellan, Brent; Cook, P. Christopher; Leahey, J L; Hyndman, John C.; El-Hawary, Ron

doi:10.1097/bpo.0b013e31821addcf

Cited by 26 publications

(11 citation statements)

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“…One of the four groups who treat children with supracondylar humerus fractures within our city prefers to treat the majority of extension type II fractures with closed reduction and cast immobilization in the emergency department and then close follow-up to determine the need for surgery, while the other practices typically favor planned delayed closed reduction and percutaneous pinning. Operative and nonoperative treatment are both supported in the literature [ 4 , 5 , 7 – 9 , 13 , 15 , 30 ], although operative management is advocated by the AAOS [ 3 ]. While some may argue that surgical treatment is not required to manage these fractures due to satisfactory long-term results [ 31 ], the need for close follow-up is still important to avoid loss of reduction and malunion in either treatment method, as long-term angular deformity can result in symptomatic cubitus varus or loss of flexion [ 2 , 27 – 29 , 32 – 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have found no difference in complication rates between early versus delayed treatment of a type 2 fracture pattern, allowing outpatient surgery and potentially lower costs to the healthcare system [ 4 – 6 ]. Closed treatment with reduction and casting may also result in excellent radiographic and clinical outcomes assuming early follow-up and no loss of reduction [ 7 – 9 ]. Regardless of the definitive treatment, limitations in access to care can jeopardize the feasibility of a delayed surgery, as patients requiring close follow-up may not be able to obtain access to a provider in time to have surgery.…”

Section: Introductionmentioning

confidence: 99%

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Impact of insurance status on ability to return for outpatient management of pediatric supracondylar humerus fractures

Fletcher

Sirmon

Mansour

et al. 2016

Journal of Children's Orthopaedics

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PurposeOutcomes are excellent following surgical management of displaced supracondylar humerus fractures. Short delays until surgical fixation have been shown to be equivalent to immediate fixation with regards to complications. We hypothesized that insurance coverage may impact access to care and the patient’s ability to return to the operating room for outpatient surgery.MethodsA retrospective review of supracondylar humerus fractures treated at a large urban pediatric hospital from 2008 to 2012 was performed. Fractures were classified by the modified Gartland classification and baseline demographics were collected. Time from discharge to office visits and subsequent surgical fixation was calculated for all type II fractures discharged from the emergency department. Insurance status and primary carrier were collected for all patients.Results2584 supracondylar humerus fractures were reviewed, of which 584 were type II fractures. Of the 577 type II fractures with complete records, 383 patients (61 %) were admitted for surgery and the remaining 194 were discharged with plans for outpatient follow-up. There was no difference in insurance status between patients admitted for immediate surgery. Of the 194 patients who were discharged with type 2 fractures after gentle reduction, 59 patients (30.4 %) ultimately underwent surgical fixation. Of these, 42 patients were privately insured (58.3 % of patients with private insurance), 16 had governmental insurance (15.1 %), and 1 was uninsured (6.3 %). Patients with private insurance were 2.46 times more likely to have surgery than patients with public or no insurance (p = 0.005). Of the 135 patients who did not eventually have surgery, 92 (68.1 %) were seen in the clinic. Patients with private insurance were 2.78 times more likely to be seen back in the clinic when compared to publicly insured or uninsured patients (p = 0.0152).ConclusionsDespite an equivalent number of privately insured and publicly insured patients undergoing immediate surgery for type II fractures, those with public or no insurance who were discharged were 2.46 times less likely to obtain outpatient surgery when compared to privately insured patients. Patient insurance status and the ability to follow up in a timely manner should be assessed at the time of initial evaluation in the emergency department.Level of evidence Level 3

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of insurance status on ability to return for outpatient management of pediatric supracondylar humerus fractures

Fletcher

Sirmon

Mansour

et al. 2016

Journal of Children's Orthopaedics

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“…Supracondylar humerus fractures are common injuries in children which often require operative fixation for optimal outcome [ 1 , 3 ]. Previous studies have demonstrated relatively low rates of complications with surgical management of these fractures, leading some authors to suggest routine surgical management of these fractures presenting with any fracture displacement [ 2 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Complications and Predictors of Need for Return to the Operating Room in the Treatment of Supracondylar Humerus Fractures in Children

Oetgen¹,

Mirick²,

Atwater³

et al. 2015

TOORTHJ

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Supracondylar humerus fractures are common pediatric injuries. Little is known about the risk factors for repeat operative procedures. A retrospective chart review of 709 patients treated for a displaced supracondylar humerus fracture was performed to identify risk factors for return to the operating room during the initial post-operative period. Deviations of routine fracture care were recorded and complication rates were compared between Gartland type 2 and 3 fractures using logistic regression. Type 3 fractures were found to have a higher complication rate, and, specifically, more peri-operative nerve palsies, more likely to need to return to the operating room for hardware removal, to lose fracture reduction, and require a return to the operating room for any reason. Five risk factors which may require returning to the operating room were identified: younger patient age, left sided fractures, type 3 fractures, peri-operative nerve palsy, and post-operative infection. In conclusion, Gartland type 3 supracondylar humerus fractures are associated with more complications then type 2 fractures. Risk factors for the need to return to the operating room in the post-operative period include: younger patient age, left sided fractures, type 3 fractures, peri-operative nerve palsy, and post-operative infection. Patients with these risk factors should be considered at risk for return to the OR and fracture fixation and follow up protocols should be adjusted for this risk.Level of Evidence : Prognostic Study, Level II.

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“…The shaft condylar angle (SCA) difference of less than 18° is classified as type IIA [4]. Many surgeons advocated closed reduction (CR) and casting as a treatment for a minimally displaced type II fracture (or type IIA) with good results [5][6][7][8][9][10][11][12][13]. On the other hand, others preferred CRPP for a more severe type II fracture (or type IIB).…”

Section: Introductionmentioning

confidence: 99%

Is subclassification of Gartland extension-type pediatric supracondylar fracture into types IIA and IIB necessary for treatment decision? A result of pediatric orthopedist’s survey and review of literature

Tangadulrat

Adulkasem

Suganjanasate

et al. 2022

Journal of Pediatric Orthopaedics B

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Extension-type pediatric supracondylar humeral fractures are very common. The Gartland classification is typically used to guide treatment. However, there is still no consensus on what factors should be used to subclassify the type II fractures and whether subclassification is needed to guide treatment. Therefore, we aim to explore the opinions of pediatric orthopedists on the treatment method of the Gartland type II supracondylar fracture. Specifically, we ask what factors are considered for their treatment decisions and whether subclassification is needed to guide treatment. An online questionnaire was developed and sent to the Thai Paediatric Orthopedics Society and Asia-Pacific Paediatric Orthopaedic Society members. The results were analyzed to explore the relationship between respondents' demographic factors and treatment decisions. Out of 113 participants reached, 57 (50.4%) responded to the questionnaire. Factors chosen by respondents are stability testing intraoperatively (73.7%), the relationship of the anterior humeral line and capitellum (66.7%), the presence of rotation (50.9%), the presence of translation (47.4%), the presence of medial comminution 42.1%), soft tissue condition(38.6%), the shaft -condylar angle (31.6%), and the Bauman angle (21.1%). Thirty-three of 57 respondents (57.9%) deemed subclassification for Gartland type II necessary for guiding treatment. About half of respondents in our study deemed the current Gartland type II subclassification necessary to guide treatment, which may indicate that the subclassification might not be sufficiently comprehensive and reliable. Therefore, better criteria for a subclassification and a prospective evaluating study might be needed.

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Extension Type II Pediatric Supracondylar Humerus Fractures

Abstract: From this radiographic review, it was observed that not all fractures treated with closed reduction and cast immobilization achieved anatomic position and alignment at final follow-up; however, the long-term clinical and radiographic significance of these findings remains unknown.

Cited by 26 publications

References 1 publication

Impact of insurance status on ability to return for outpatient management of pediatric supracondylar humerus fractures

Impact of insurance status on ability to return for outpatient management of pediatric supracondylar humerus fractures

Complications and Predictors of Need for Return to the Operating Room in the Treatment of Supracondylar Humerus Fractures in Children

Is subclassification of Gartland extension-type pediatric supracondylar fracture into types IIA and IIB necessary for treatment decision? A result of pediatric orthopedist’s survey and review of literature

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