Functional and radiographic outcomes of Gartland type II supracondylar humerus fractures managed by closed reduction under nitrous oxide as conscious sedation

Abstract

The management of Gartland type II supracondylar fractures remains controversial. This study aimed to evaluate the clinical, functional, and radiographic outcomes of Gartland type II supracondylar fractures treated by immediate closed reduction and casting in the emergency department using equimolar nitrous oxide as conscious sedation. All patients were treated non-operatively using equimolar nitrous oxide as conscious sedation during closed reduction and cast immobilization. Three out of 34 patients (three elbows; 8.8%) were lost during follow-up. The mean follow-up time was 26.4 months (range: 6–48). The mean Quick DASH score at cast removal was 22.4 (range: 19–40) and 2.3 (range: 0–9) at the last follow-up visit in patients without secondary displacement (n = 26; 76.5%). The mean Quick-DASH score of patients (n = 5; 16.1%) requiring closed reduction and percutaneous pinning under general anesthesia because of secondary displacement was 21.4 (range: 19–25) at cast removal and 0.9 (range: 0–2.3) at the last follow-up visit. No significant differences between the two groups were found at any time (P = 0.38 and P = 0.48, respectively). The two groups also showed a comparable radiographic outcome and similar Flynn’s criteria. The mean Numeric Pain Intensity was three (range: 0–6). No complications related to the administration of equimolar nitrous oxide were recorded. The use of equimolar nitrous oxide as conscious sedation for closed reduction and casting appears to be a safe, inexpensive, and appropriate conservative method of treatment for displaced Gartland type II supracondylar fractures in children. A regular follow-up is mandatory to detect early secondary displacement, as 16.1% of fractures required additional closed reduction and percutaneous pinning under general anesthesia. Level IV, retrospective study.

Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society

“…In particular, type IIA SHFs are characterized by a displacement of 2–15 mm on the lateral or the anterior–posterior (AP) view and a 15°–20° retro-tilt on the lateral view with a partially intact posterior cortex, while type IIB SHFs, in addition to displacement and retro-tilt, also have a rotatory malalignment. 11 , 12 Most type II SHFs fractures have been traditionally managed surgically. However, some authors agree that conservative treatment may be a valuable option in type IIA SHFs.…”

“…However, some authors agree that conservative treatment may be a valuable option in type IIA SHFs. 11 , 12 The purpose of this study was to evaluate the current trends in the treatment of SHFs as well as the preferred post-operative follow-up protocol among members of the European Paediatric Orthopaedic Society (EPOS).…”

Radiographic assessments of pediatric supracondylar fractures and mid-term patient-reported outcomes

“…Notably, the QuickDASH scores were similar to those reported in other outcome studies of SCH fractures. [ 30 , 31 ] Because the primary aim of our study was to investigate mid-term functional outcomes at 1 time point after SCH fracture, the presence of a ceiling or floor effect should not detract from our finding that all patients had excellent outcomes as measured by the selected PROs. Finally, our surgically treated population may not reflect extremes of potential deformity because they had been surgically treated.…”

Range of motion following percutaneous fixation of pediatric supracondylar humerus fracture is independent of anterior osseous fragment resorption

“…Lastly, we were unable to implement the DASH or quick DASH questionnaires to covalidate our functional outcomes due to the retrospective nature of this study. Pierantoni et al [19] utilized quick DASH to evaluate functional outcomes in the pediatric population after undergoing supracondylar fracture fixation. We attempted to contact previous patients; however, due to long duration of elapsed time since the index surgeries, most patients had moved, changed names, or no longer were able to be located.…”