Timing of surgical treatment for type III supracondylar humerus fractures in pediatric patients

Abstract

Reduction became technically more difficult as TS increased.

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

“…Other investigations show that delaying treatment leads to an increase in open surgery or complications [9][10][11]. In order to answer these questions for patients seen at our institution, we conducted a retrospective investigation, examining preoperative risk factors, treatment, postoperative complications, and functional status for patients treated for these fractures.…”

“…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]. As noted, there is still some debate as to whether these fractures should be treated as urgent cases with early intervention, or if patients with delayed treatment also experience satisfactory outcomes [1][2][3][4][5][12][13][14][15].…”

Is outcome of delayed fixation is comparable with early fixation in type 3 supracondylar humerus fracture in children

“…The authors have suggested that the probability of switching to open surgery increased by a factor of 4 every 5 hours beginning 15 hours after injury and open surgery is necessary after 32 hours. [4] Our study is limited by the fact that we could not evaluate the maximum limit to delay in the treatment and thus we recommend, that though the management of type III supracondylar humeral fracture is regarded as an urgency rather than an emergency, surgeons should be aware of the fact that they may lose the opportunity to perform closed reduction after 32 h post-injury.…”

“…Considering the severity of the injury, an immediate closed reduction is advised to minimize the possibility of further swelling leading to compartment syndrome and neurovascular compromise of the limb. Moreover, as the fixation is delayed, closed manoeuvre poses difficulties increasing the need for open reduction [2,4] . Open reduction is associated with severe disabling complications such as myositis ossificans, and stiffness of elbow, nerve and vascular injuries, and Volkmann's ischemic contracture (VIC) [5,6] .…”

“…This is a major factor responsible for significant delay in treatment initiation in some cases. A thorough literature search indicated that supracondylar fractures of the humerus in children is associated with some serious complications, including compartment syndrome which necessitates and benefits from an urgent treatment [2,4] . Though urgent treatment is necessary for supracondylar humerus fracture in childrens, Studies by Ahmed et al [4] , Mehlman et al [7] , Iyenger et al [8] , Leet et al [14] and Gupta et al [10] have shown that a delay in surgery of up to 32 hours does not significantly alter complication rates or the need for open reduction in children undergoing surgical treatment of supracondylar fractures of the humerus.…”