Displaced supracondylar humeral fractures: influence of delay of surgery on the incidence of open reduction, complications and outcome

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• 作者：Timo Schmid ; Alexander Joeris ; Theddy Slongo…
• 关键词：Children ; Supracondylar humeral fracture ; Delay of treatment ; Open reduction ; Complications
• 刊名：Archives of Orthopaedic and Trauma Surgery
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：135
• 期：7
• 页码：963-969
• 全文大小：384 KB
• 参考文献：1.Beaty JH (2003) Elbow fractures in children and adolescents. Instr Course Lect 52:661-65PubMed
  2.Houshian S, Mehdi B, Larsen MS (2001) The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci 6(4):312-15. doi:10.-007/?s0077610060312 PubMed View Article
  3.Otsuka NY, Kasser JR (1997) Supracondylar Fractures of the Humerus in Children. J Am Acad Orthop Surg 5(1):19-6PubMed
  4.Cheng JC, Lam TP, Shen WY (1995) Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. J Orthop Trauma 9(6):511-15PubMed View Article
  5.Omid R, Choi PD, Skaggs DL (2008) Supracondylar humeral fractures in children. J Bone Joint Surg Am 90(5):1121-132. doi:10.-106/?JBJS.?G.-1354 PubMed View Article
  6.Pirone AM, Graham HK, Krajbich JI (1988) Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg Am 70(5):641-50PubMed
  7.Ponce BA, Hedequist DJ, Zurakowski D, Atkinson CC, Waters PM (2004) Complications and timing of follow-up after closed reduction and percutaneous pinning of supracondylar humerus fractures: follow-up after percutaneous pinning of supracondylar humerus fractures. J Pediatr Orthop 24(6):610-14 00004694-200411000-00002 [pii] PubMed View Article
  8.Reynolds RA, Jackson H (2005) Concept of treatment in supracondylar humeral fractures. Injury 36(Suppl 1):A51–A56. doi:10.-016/?j.?injury.-004.-2.-13 PubMed View Article
  9.Colaris JW, Horn TM, van den Ende ED, Allema JH, Merkus JW (2008) Supracondylar fractures of the humerus in children. Comparison of results in two treatment periods. Acta Chir Belg 108(6):715-19PubMed
  10.von Laer L, Gunter SM, Knopf S, Weinberg AM (2002) Supracondylar humerus fracture in childhood—an efficacy study. Results of a multicenter study by the Pediatric Traumatology Section of the German Society of Trauma Surgery–II: costs and effectiveness of the treatment. Unfallchirurg 105(3):217-23View Article
  11.Weinberg AM, Marzi I, Gunter SM, Wessel L, Riedel J, von Laer L (2002) Supracondylar humerus fracture in childhood—an efficacy study. Results of a multicenter study by the Pediatric Traumatology Section of the German Society of Trauma Surgery–I: epidemiology, effectiveness evaluation and classification. Unfallchirurg 105(3):208-16PubMed View Article
  12.Yildirim AO, Unal VS, Oken OF, Gulcek M, Ozsular M, Ucaner A (2009) Timing of surgical treatment for type III supracondylar humerus fractures in pediatric patients. J Child Orthop 3(4):265-69. doi:10.-007/?s11832-009-0189-2 PubMed Central PubMed View Article
  13.Bales JG, Spencer HT, Wong MA, Fong YJ, Zionts LE, Silva M (2010) The effects of surgical delay on the outcome of pediatric supracondylar humeral fractures. J Pediatr Orthop 30(8):785-91. doi:10.-097/?BPO.-b013e3181f9fc03-/span> PubMed View Article
  14.Farley FA, Patel P, Craig CL, Blakemore LC, Hensinger RN, Zhang L, Caird MS (2008) Pediatric supracondylar humerus fractures: treatment by type of orthopedic surgeon. J Child Orthop 2(2):91-5. doi:10.-007/?s11832-008-0089-x PubMed Central PubMed View Article
  15.O’Hara LJ, Barlow JW, Clarke NM (2000) Displaced supracondylar fractures of the humerus in children. Audit changes practice. J Bone Joint Surg Br 82(2):204-10PubMed View Article
  16.Giannini S, Maffei G, Girolami M, Ceccarelli F (1983) The treatment of supracondylar fractures of the humerus in children by closed reduction and fixation with percutaneous Kirschner wires. Ital J Orthop Traumatol 9(2):181-88PubMed
  17.Jacobs RL (1967) Supracondylar fracture of the humerus in children. IMJ Ill Med J 132(5):696-01PubMed
  18.Minkowitz B, Busch MT (1994) Supracondylar humerus fractures. Current trends and controversies. Orthop Clin North Am 25(4):581-94PubMed
  19.Paradis G, Lavallee P, Gagnon N, Lemire L (1993) Supracondylar fractures of the humerus in children. Technique and results of crossed percutaneous K-wire fixation. Clin Orthop Relat Res 297:231-37PubMed
  20.Segal D (1979) Pediatric orthopedic emergencies. Pediatr Clin North Am 26(4):793-02PubMed
  21.Walmsley PJ, Kelly MB, Robb JE, Annan IH, Porter DE (2006) Delay increases the need for open reduction of type-III supracondylar fractures of the humerus. J Bone Joint Surg Br 88(4):528-30. doi:10.-302/-301-620X.-8B4.-7491 PubMed View Article
  22.Ramachandran M, Skaggs DL, Crawford HA, Eastwood DM, Lalonde FD, Vitale MG, Do TT, Kay RM (2008) Delaying treatment of supracondylar fractures in children: has the pendulum swung too far? J Bone Joint Surg Br 90(9):1228-233. doi:10.-302/-301-620X.-0B9.-0728 PubMed View Article
  23.Keon-Cohen BT (1966) Fractures at the elbow. J Bone Joint Surg Am 48(8):1623-639PubMed
  24.Loizou CL, Simillis C, Hutchinson JR (2009) A systematic review of early versus delayed treatment for type III supracond
• 作者单位：Timo Schmid (1)
  Alexander Joeris (2)
  Theddy Slongo (3)
  Sufian S. Ahmad (1)
  Kai Ziebarth (3)
  
  1. Department of Orthopedic Surgery, Inselspital University of Bern, 3010, Bern, Switzerland
  2. AO Foundation, AO Clinical Investigation and Documentation, 8600, Dübendorf, Switzerland
  3. Department of Pediatric Surgery, Inselspital University of Bern, 3010, Bern, Switzerland
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Orthopedics
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1434-3916

文摘

Background Closed reduction and pinning is the accepted treatment choice for dislocated supracondylar humeral fractures in children (SCHF). Rates of open reduction, complications and outcome are reported to be dependent on delay of surgery. We investigated whether delay of surgery had influence on the incidence of open reduction, complications and outcome of surgical treatment of SCHFs in the authors-institution. Methods Three hundred and forty-one children with 343 supracondylar humeral fractures (Gartland II: 144; Gartland III: 199) who underwent surgery between 2000 and 2009 were retrospectively analysed. The group consisted of 194 males and 149 females. The average age was 6.3?years. Mean follow-up was 6.2?months. Time interval between trauma and surgical intervention was determined using our institutional database. Clinical and radiographical data were collected for each group. Influence of delay of treatment on rates of open reduction, complications and outcome was calculated using logistic regression analysis. Furthermore, patients were grouped into 4 groups of delay (<6?h, n?=?166; 6-2?h, n?=?95; 12-4?h, n?=?68;?>24?h, n?=?14) and the aforementioned variables were compared among these groups. Results The incidence of open procedures in 343 supracondylar humeral fractures was 2.6?%. Complication rates were similar to the literature (10.8?%) primarily consisting of transient neurological impairments (9.0?%) which all were fully reversible by conservative treatment. Poor outcome was seen in 1.7?% of the patients. Delay of surgical treatment had no influence on rates of open surgery (p?=?0.662), complications (p?=?0.365) or poor outcome (p?=?0.942). Conclusions In this retrospective study delay of treatment of SCHF did not have significant influence on the incidence of open reduction, complications, and outcome. Therefore, in SCHF with sufficient blood perfusion and nerve function, elective treatment is reasonable to avoid surgical interventions in the middle of the night which are stressful and wearing both for patients and for surgeons. Level of evidence III (retrospective comparative study).