The Effect of Surgical Timing on the Perioperative Complications of Treatment of Supracondylar Humeral Fractures in Children

Mehlman, Charles T.; Strub, William M.; Roy, Dennis R.; Wall, Eric J.; Crawford, Alvin H.

doi:10.2106/00004623-200103000-00002

Cited by 235 publications

(164 citation statements)

References 27 publications

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“…There was no difference in the loss of reduction with respect to timing of surgery in our study. This result is in concurrence with many previous studies which found no difference in those cases treated immediately within 8 h of injury and those treated more than 8 h after the injury [31] . However if limb is grossly swollen, ecchymoses or with neurovascular compromise, should be operated at earliest.…”

Section: Discussionsupporting

confidence: 92%

Incidence of residual varus deformity in operated cases of supracondylar humerus fracture in children

Aiyer¹,

Naskar²,

Raja³

et al. 2017

Int. J. Orthop. Sci.

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Supracondylar fractures in children are very frequently occurring fracture in children requiring surgical treatment. The aim of surgery is to mainly prevent future cubitus varus deformity. However even after surgery and restoration of the carrying angle many children presents with varus deformity or reduction in carrying angle. The aim of our study was to see the incidence of such varus deformity in postoperative cases. We have studied 160 cases of supracondylar humerus fracture who have undergone surgery, open reduction and cross K-wire fixation and we have found that almost 24% cases there were loss of carrying angle but only few of them were clinically significant. So we can conclude that closed reduction and K wire fixation is an effective mode of treatment for supracondylar humerus fracture in children to prevent future varus deformity.

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Section: Discussionsupporting

confidence: 92%

Incidence of residual varus deformity in operated cases of supracondylar humerus fracture in children

Aiyer¹,

Naskar²,

Raja³

et al. 2017

Int. J. Orthop. Sci.

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“…Two hundred and twenty-six patients were included for the final analysis. Patients were distributed into the different surgical approaches as follows: lateral (58) [2,7,21], medial (50) [21,26,39], posterior (47) [1,21,26], anterior (65) [35,39], and medial ? lateral (6) [21,26,39].…”

Section: Methodsmentioning

confidence: 99%

Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: A systematic review

Mazzini

Martín

Esteban

2010

Journal of Children's Orthopaedics

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Purpose There is no clear evidence in the actual literature regarding which of the surgical approaches could bring about the best functional, cosmetic, and radiological outcomes, as well as fewer complications, when an open reduction and pinning of a severely displaced supracondylar humerus fracture is performed. We, therefore, performed a systematic review of the English literature to investigate the existing evidence regarding this issue. Methods A MEDLINE and EMBASE databases search was performed to identify articles that focused on the functional, cosmetic, and radiological outcomes, as well as post-surgical complications, regarding different surgical approaches used for open reduction and pinning in severely displaced supracondylar humerus fractures in children. One hundred and ninety-four articles were identified, of which seven were included for review. Data analysis included weighted means for all contingency tables and the Chi-square test. Standardized residues were studied when the Chi-square test was statistically significant. Statistical analyses were conducted using Stata 9.1/SE (StataCorp., College Station, TX) and P-values lower than 0.05 were considered to be statistically significant for all analyses. Results For functional outcome, a high frequency of excellent results was found within the lateral and medial approaches, and a high frequency of good results within the anterior approach. A high frequency of poor results was found within the posterior approach. For cosmetic outcome, there was a high frequency of fair results within the posterior and lateral approaches, and a high frequency of poor results within the posterior approach. No statistically significant difference regarding time to union, as well as complications, was found. Conclusion Our results suggest that a combined anteromedial approach could be the method which allows the achievement of better functional and cosmetic outcome according to Flynn's criteria. Time to union, as well as post-surgical complications, should not be an issue regarding surgical approaches used for open reduction and pinning in these fractures.

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“…More recently, it has been proposed that delaying treatment is acceptable, with no adverse outcomes resulting from delayed treatment [2]. Recent investigations evaluating children with supracondylar humerus fractures found no difference between patients with early or delayed treatment for the following parameters: functional status including carrying angle or Baumann's angle, grip strength, and range of motion; rates of complications including pintrack infection, nerve injury, and occurrence of compartment syndrome; as well as the need for open surgery [6][7][8]. In contrast, there are studies which support the case for early treatment, demonstrating that reduction becomes more difficult for patients with delayed treatment, and the occurrence of compartment syndrome in patients whose treatment is delayed [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

An evaluation of supracondylar humerus fractures: Is there a correlation between postponing treatment and the need for open surgical intervention?

Kronner

Legakis

Kovacevic

et al. 2013

Journal of Children's Orthopaedics

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Purpose The goal of this study was to evaluate the treatment and recovery of patients treated for Gartland type III supracondylar humerus fractures in order to determine if postponing treatment leads to a higher rate of open surgical treatment or complications. Methods A retrospective study was conducted examining the medical records of children with Gartland type III supracondylar humerus fractures at our institution for a two-year period. The patients included in the study were treated with closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF). Results After exclusions, 134 patients were included in the study, with an average age of 5.6 years. The patients were grouped according to whether their treatment was postponed (39.6 %) or immediate (60.4 %). The majority of all patients were treated using CRPP: 46 (86.8 %) of the postponed patients and 75 (92.6 %) of the immediate patients. Very few postsurgical complications occurred in the patients; there was only one (1.6 %) case of iatrogenic nerve injury in a postponed patient as well as four (3.8 %) cases of loss of carrying angle: one (2.3 %) in postponed patients and three (4.8 %) in immediate patients. Conclusions Postponing treatment of type III supracondylar humerus fractures in children did not lead to an increase in open surgical treatment; nor did it lead to an increase in complications.

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The Effect of Surgical Timing on the Perioperative Complications of Treatment of Supracondylar Humeral Fractures in Children

Cited by 235 publications

References 27 publications

Incidence of residual varus deformity in operated cases of supracondylar humerus fracture in children

Incidence of residual varus deformity in operated cases of supracondylar humerus fracture in children

Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: A systematic review

An evaluation of supracondylar humerus fractures: Is there a correlation between postponing treatment and the need for open surgical intervention?

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