Karnes JM and Lubicky JP*
Department of Orthopaedics, West Virginia University, USAFulltext PDF
Background: In our rural state, most children with supracondylar humerus fractures (SCFs) are referred to our tertiary care medical center. Over a 4+ year period, the one pediatric orthopaedic surgeon in the state surgically treated more than 200 SCFs using a standard protocol. Closed reduction (CR) and percutaneous pinning was attempted in all cases. Open reduction and percutaneous pinning (OR/PP) was required in some. The purpose of this study was to review one surgeon’s experience with the surgical treatment of SCF with a focus on fracture type and pattern and the need for open reduction as well as the incidence of nerve injuries.Methods: Institutional Review Board approval for a retrospective chart review was attained and medical records of pediatric patients treated at our institution between 01/2010 and 09/2014 were reviewed. Current Procedural Terminology codes 24538, 24545, and 24546 were used to identify patients. Data were examined using summary statistics and Chi-square tests.Results: Two hundred four patients were included in this study and 25 eventually required OR/ PP for definitive management. The following factors were not statistically associated with OR/PP: fracture pattern, Gartland classification, laterality of extremity, or gender; however, age, presence of neurological symptoms on initial evaluation, and energy of fracture etiology were significantly associated. In 71 cases, a “U” shaped distal fragment was identified. The most common neurological symptoms on initial presentation were anterior interosseous nerve palsy (n=10, 4.9%) and nondermatomal paresthesias (n=5, 2.5%). Factors significantly associated with neurological symptoms on initial presentation included: need for open reduction, medial-lateral pinning construct, Gartland Type III injury, age, and “U-shaped” fracture pattern.Conclusions: No identified fracture pattern was significantly associated with need for open reduction; however, a previously undescribed “U-shaped” fracture pattern did have a significant association with neurological symptoms. Patients most likely to require OR/PP for a SCF were children over the age of five who presented with neurological symptoms on initial evaluation and/or had a high-energy injury etiology. The main indication for OR/PP was failure to achieve a satisfactory CR. Orthopaedic surgeons managing these fractures should have a low threshold to transition to an open procedure in patients with these risk factors if closed fracture reduction cannot be achieved expeditiously.
Supracondylar fracture; Open reduction
Karnes JM, Lubicky JP. The Treatment of Pediatric Supracondylar Humerus Fractures: Experience in a Tertiary Medical Center in a Rural State. Clin Surg. 2016; 1: 1082.