Orthopedic versus surgical treatment of Gartland type II supracondylar humerus fracture in children

Miranda, Ignacio; Sánchez-Arteaga, Paulino; Marrachelli, Vannina G.; Miranda, Francisco Javier Noya; Taverner, M. Salom

doi:10.1097/01.bpb.0000434241.56816.c8

Cited by 20 publications

(15 citation statements)

References 32 publications

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“…We found 28 studies examining outcome data of closed reduction and casting for displaced supracondylar fractures. 17–43 This included any method of immobilisation whereby plaster of Paris was applied to the injured arm, set under any degree of flexion. Closed reduction was performed and, where specified, manipulation of the displaced injury was performed under general anaesthetic, local block or sedation.…”

Section: Resultsmentioning

confidence: 99%

“…32,37 In two articles, when a distinction was drawn between Gartland type II and III injuries, casting was found to provide unsatisfactory outcome in type III, but good results in type II. 32,37…”

Section: Resultsmentioning

confidence: 99%

“…Although a number of articles continue to advocate the method, especially in a low-income setting, 43 others suggest operative fixation provides superior outcomes. 32,37 In two articles, when a distinction was drawn between Gartland type II and III injuries, casting was found to provide unsatisfactory outcome in type III, but good results in type II. 32,37…”

Section: Closed Reduction and Castingmentioning

confidence: 99%

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Conservative management of displaced paediatric supracondylar fractures: a systematic review

et al. 2018

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In low-income countries, where surgical expertise and resources are limited, displaced supracondylar fractures of the distal humerus are routinely managed with traction or closed reduction and casting. This is in contrast to high-income nations, where percutaneous K-wire fixation forms the mainstay of treatment. The aim of our study is to present the published evidence regarding the outcome of conservatively managed displaced supracondylar fractures in children. A systematic review of the literature was performed identifying 46 studies evaluating the outcome of displaced supracondylar fractures managed non-operatively. Our results show management by traction is equivalent to percutaneous pinning, whereas outcomes following closed reduction and casting were inconsistent. Traction therefore remains a viable option in low- and middle-income countries (LMICs). However, at present there are few data from LMICs, limiting the transferability of our conclusions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Closed Reduction and Castingmentioning

confidence: 99%

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Conservative management of displaced paediatric supracondylar fractures: a systematic review

et al. 2018

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“…[ 23 ] Despite several studies having investigated the effect of postoperative Baumann angle on cubitus varus deformity and carrying angle after SCH, none has established an association with PROs. [ 7 , 24 , 25 ] Our data suggest that patients with incomplete reduction as measured by postoperative Baumann angle have equivalent mid-term function to those with near complete/complete reductions. Overall, it appears that children have excellent outcomes, as measured by parent proxy PROs, after surgical reduction of SCH fracture, regardless of the quality of reduction.…”

Section: Discussionmentioning

confidence: 70%

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

et al. 2020

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Radiographic parameters are commonly used to determine the need for surgical supracondylar humeral (SCH) fracture reduction and the postoperative quality of reduction. We studied whether such parameters are correlated with mid-term patient-reported outcome (PRO) scores in pediatric patients. We retrospectively reviewed data from 213 patients (104 girls) treated surgically for Gartland type-II (n = 84) or type-III (n = 129) SCH fractures from 2008–2016. Mean (± standard deviation) age at surgery was 5.1 ± 2.1 years. Mean time from initial treatment to outcome survey completion was 5.0 ± 2.1 years (range, 2.0–10 years). We evaluated preoperative radiographs for coronal/sagittal fracture displacement, presence of impaction/comminution, Gartland classification, and rotation. Patients, parents were asked via telephone to complete the QuickDASH (Quick Disability of the Arm, Shoulder, and Hand) and PROMIS (Patient-Reported Outcomes Measurement Information System) Strength Impact, Upper Extremity, and Pain Interference questionnaires. Parents were also asked whether the previously fractured arm appeared normal or abnormal. We evaluated postoperative radiographs for coronal/sagittal deformity, Baumann angle, and rotation and classified reductions as near complete/complete or incomplete. Anterior humeral line through the capitellum, Baumann angle in the 7.5th to 92.5th percentile of the sample, or rotation ratio between 0.85 and 1.15 were considered near complete/complete reductions; all others were considered incomplete. Bivariate analysis was used to determine whether radiographic parameters and arm appearance were associated with QuickDASH and PROMIS scores. Patients with Gartland type-III fractures had significantly greater disability on the QuickDASH at follow-up compared with those with Gartland type-II fractures ( P < .01). It is unknown if this statistical difference translates to clinical relevance. No other preoperative or postoperative radiographic parameter was significantly associated with PRO scores. There was no association between fractured arm appearance at follow-up and PRO scores. Radiographic parameters that are used to evaluate the need for and quality of pediatric SCH fracture reduction are not significantly associated with mid-term PROMIS and QuickDASH scores. LOE: Prognostic Level III.

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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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Orthopedic versus surgical treatment of Gartland type II supracondylar humerus fracture in children

Cited by 20 publications

References 32 publications

Conservative management of displaced paediatric supracondylar fractures: a systematic review

Conservative management of displaced paediatric supracondylar fractures: a systematic review

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

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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