Pediatric Supracondylar Humerus Fractures: Does After-Hours Treatment Influence Outcomes?

Paci, Gabrielle M.; Tileston, Kali; Vorhies, John S.; Bishop, Julius A.

doi:10.1097/bot.0000000000001134

Cited by 16 publications

(21 citation statements)

References 34 publications

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“…All six articles articles retrospectively compared postoperative outcomes of pediatric patients who had surgery for supracondylar humerus fractures at different times of the day. Primary outcomes in the studies were reduction quality [ 14 , 15 , 16 , 17 , 18 , 19 ], malunion rate [ 15 ], loss of reduction [ 17 ] and complications [ 16 ]. Also, functional outcomes in follow-up were assessed in three articles [ 14 , 15 , 16 ].…”

Section: Resultsmentioning

confidence: 99%

Pediatric Supracondylar Humerus Fractures: Should We Avoid Surgery during After-Hours?

et al. 2022

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Pediatric supracondylar humerus fractures occur frequently. Often, the decision has to be made whether to operate immediately, e.g., during after-hours, or to postpone until office hours. However, the effect of timing of surgery on radiological and clinical outcomes is unclear. This literature review with the PICO methodology found six relevant articles that compared the results of office-hours and after-hours surgery for pediatric supracondylar humerus fractures. The surgical outcomes of both groups in these studies were assessed. One of the articles found a significantly higher “poor fixation rate” in the after-hours group, compared with office hours. Another article found more malunions in the “night” subgroup vs. the “all groups but night” group. A third article found a higher risk of postoperative paresthesia in the “late night” subgroup vs. the “day” group. Lastly, one article reported increased consultant attendance and decreased operative time when postponing to office hours more often. No differences were reported for functional outcomes in any of the articles. Consequently, no strong risks or benefits from surgical treatment during office hours vs. after-hours were found. It appears safe to postpone surgery to office hours if circumstances are not optimal for acute surgery, and if there is no medical contraindication. However, research with a higher level-of-evidence is needed make more definite recommendations.

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Section: Resultsmentioning

confidence: 99%

Pediatric Supracondylar Humerus Fractures: Should We Avoid Surgery during After-Hours?

et al. 2022

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“…Paci et al investigated the results of SHFs operated during working or non-working hours. They reported no difference in terms of operative duration and outcomes, however mal-union rate was higher in patients operated at night in non-working hours (7). Yıldırım et al reported similar reduction quality in pediatric SHFs who were operated in the same or next day of their admission.…”

Section: Discussionmentioning

confidence: 96%

“…Operating the pediatric SHF patients within working or non-working hours is still debating in the literature. In recent studies, mal-union rates were reported to be higher in pediatric SHFs operated in the night hour surgeries and mean operative duration was found to be shorter in daytime surgeries (7,8). On the other hand, in a recent article, there was no difference in reduction quality, complications and outcomes between pediatric SHF patients operated during the night or the daytime (9).…”

Section: Introductionmentioning

confidence: 99%

Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours?

Okkaoğlu

Ozdemir

Özdemir

et al. 2021

Preprint

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Background:We aimed to determine the ideal surgical timing in the first 24 hours after admission to the hospital of pediatric supracondylar humerus fractures (SHF) that do not require emergent intervention. Materials and Methods:Patients who underwent surgery in our institution between January 2011 and January 2019 due to pediatric Gartland type 3 SHFs were evaluated retrospectively. Open fractures, fractures associated with vascular injury and compartment syndrome, flexion type fractures were excluded. A total of 150 Gartland type 3 were included. The effect of early (<12 hours) or late (>12 hours) surgical interventions, daytime or night-time surgeries, working or non-working hour surgeries on operative parameters (operative duration and open reduction rate, reduction quality on postoperative early radiographs) were evaluated in pediatric SHFs. Results:Early (<12 hours) or late (>12 hours), daytime or nighttime, working or non-working hour surgeries were found to be similar in Gartland type 3 patients regarding early postoperative reduction quality, duration of surgery, open reduction rate (p>0.05). Mean times passed from first admission to hospital until surgery were longer in working hour, late (>12 hours) and daytime surgery groups than non-working hour, early (<12 hours) and night-time surgery groups (p<0.001). Conclusion:Although delaying the operation to the working hours seems to prolong the time until surgery in pediatric Gartland type 3 SHF patients who do not require emergent intervention such as open fractures, neurovascular impairment and compartment syndrome, there may not be a time interval that makes a difference for the patients if surgery is performed within the first 24 hours, thus the surgery could be scheduled according to the surgeons’ preference.Level of Evidence: Level 3, Retrospective cohort study

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“…Paci et al investigated the results of SHFs operated during working or non-working hours. They reported no difference in terms of operative duration and outcomes, however, mal-union rate was higher in patients operated at night in non-working hours [ 6 ]. Yıldırım et al reported similar reduction quality in pediatric SHFs who were operated in the same or next day of their admission.…”

Section: Discussionmentioning

confidence: 99%

“…Operating the pediatric SHF patients within working or non-working hours is still debating in the literature. In recent studies, mal-union rates were reported to be higher in pediatric SHFs operated in the night hour surgeries and mean operative duration was found to be shorter in daytime surgeries [ 6 , 7 ]. On the other hand, in a recent article, there was no difference in reduction quality, complications and outcomes between pediatric SHF patients operated during the night or the daytime [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours?

et al. 2021

View full text Add to dashboard Cite

Background We aimed to determine the ideal surgical timing in the first 24 hours after admission to the hospital of pediatric supracondylar humerus fractures (SHF) that do not require emergent intervention. Materials and Methods Patients who underwent surgery in our institution between January 2011 and January 2019 due to pediatric Gartland type 3 SHFs were evaluated retrospectively. Open fractures, fractures associated with vascular injury and compartment syndrome, flexion type fractures were excluded. A total of 150 Gartland type 3 were included. The effect of early (<12 hours) or late (>12 hours) surgical interventions, daytime or night-time surgeries, working or non-working hour surgeries on operative parameters (operative duration and open reduction rate, reduction quality on postoperative early radiographs) were evaluated in pediatric SHFs. Results Early (<12 hours) or late (>12 hours), daytime or nighttime, working or non-working hour surgeries were found to be similar in Gartland type 3 patients regarding early postoperative reduction quality, duration of surgery, open reduction rate (p>0.05). Mean times passed from first admission to hospital until surgery were longer in working hour, late (>12 hours) and daytime surgery groups than non-working hour, early (<12 hours) and night-time surgery groups (p<0.001). Conclusion Although delaying the operation to the working hours seems to prolong the time until surgery in pediatric Gartland type 3 SHF patients who do not require emergent intervention such as open fractures, neurovascular impairment and compartment syndrome, there may not be a time interval that makes a difference for the patients if surgery is performed within the first 24 hours, thus the surgery could be scheduled according to the surgeons’ preference. Level of Evidence: Level 3, Retrospective cohort study

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Pediatric Supracondylar Humerus Fractures: Does After-Hours Treatment Influence Outcomes?

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 16 publications

References 34 publications

Pediatric Supracondylar Humerus Fractures: Should We Avoid Surgery during After-Hours?

Pediatric Supracondylar Humerus Fractures: Should We Avoid Surgery during After-Hours?

Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours?

Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours?

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