Supracondylar elbow fracture management (Supra Man)

Abstract

Aims Management of displaced paediatric supracondylar elbow fractures remains widely debated and actual practice is unclear. This national trainee collaboration aimed to evaluate surgical and postoperative management of these injuries across the UK. Methods This study was led by the South West Orthopaedic Research Division (SWORD) and performed by the Supra Man Collaborative. Displaced paediatric supracondylar elbow fractures undergoing surgery between 1 January 2019 and 31 December 2019 were retrospectively identified and their anonymized data were collected via Research Electronic Data Capture (REDCap). Results A total of 972 patients were identified across 41 hospitals. Mean age at injury was 6.3 years (1 to 15), 504 were male (52%), 583 involved the left side (60%), and 538 were Gartland type 3 fractures (55%). Median time from injury to theatre was 16 hours (interquartile range (IQR) 6.6 to 22), 300 patients (31%) underwent surgery on the day of injury, and 91 (9%) underwent surgery between 10:00 pm and 8:00 am. Overall, 910 patients (94%) had Kirschner (K)-wire) fixation and these were left percutaneous in 869 (95%), while 62 patients (6%) had manipulation under anaesthetic (MUA) and casting. Crossed K-wire configuration was used as fixation in 544 cases (59.5%). Overall, 208 of the fixation cases (61%) performed or supervised by a paediatric orthopaedic consultant underwent lateral-only fixation, whereas 153 (27%) of the fixation cases performed or supervised by a non-paediatric orthopaedic consultant used lateral-only fixation. In total, 129 percutaneous wires (16%) were removed in theatre. Of the 341 percutaneous wire fixations performed or supervised by a paediatric orthopaedic consultant, 11 (3%) underwent wire removal in theatre, whereas 118 (22%) of the 528 percutaneous wire fixation cases performed or supervised by a non-paediatric orthopaedic consultant underwent wire removal in theatre. Four MUA patients (6%) and seven K-wire fixation patients (0.8%) required revision surgery within 30 days for displacement. Conclusion The treatment of supracondylar elbow fractures in children varies across the UK. Patient cases where a paediatric orthopaedic consultant was involved had an increased tendency for lateral only K-wire fixation and for wire removal in clinic. Low rates of displacement requiring revision surgery were identified in all fixation configurations. Cite this article: Bone Joint J 2023;105-B(1):82–87.

The Effect of Fracture Patterns, Pinning Configuration, Surgeon Experience and Subspecialty on Short-Term Radiological Outcomes of Pediatric Supracondylar Humeral Fractures Treated in the Prone Position: A Case-Series

“…According to a national trainee collaborative evaluation of practice, in the UK the most common configuration for Gartland type 3 fracture is the crossed-wire configuration, while lateral is the preferred fixation in 2a and 2b types [25].…”

Children’s orthopaedics

“…Staying on the topic of paediatric supracondylar elbow fractures, this study is an interesting national trainee collaboration led from Torquay (UK) , which aimed to evaluate both surgery and the postoperative management of this type of injury across the UK in a so called ‘sprint audit’. 5 Trainee collaboratives are a powerful way of obtaining multicentre data, and this one was run by the South West Orthopaedic Research Division (SWORD) and performed by the ‘Supra Man’ Collaborative. Over the audit period, 972 sets of case notes were retrospectively identified across 41 hospitals, and research data was captured electronically on all paediatric supracondylar fractures undergoing surgical treatment over a one-year period.…”