OTA 1997 Posters - Pediatrics

Meta-Analysis of Outcomes following Displaced Supracondylar Humeral Fractures in Children

Charles T. Mehlman, DO, Robert J. Nowinski, DO

Children's Hospital Medical Center, Cincinnati, Ohio, USA

Purpose: Individual reports in the literature demonstrate considerable variation concerning the relative success of closed reduction and casting, traction, and closed reduction and percutaneous pinning (CRPP) treatments for displaced supracondylar humeral fractures in children. The purpose of this study was to combine and analyze comparable data from multiple studies in order to better answer such important questions.

Methods: An English language MEDLINE search along with pediatric fracture text bibliography crossreferencing identified 167 non-case report articles concerning supracondylar humeral fractures in children (13 - A2.3). Attention was focused on pooling comparable data concerning displaced fractures as these present the greatest treatment challenge. Descriptive statistics, risk ratios, and Chi square analysis were utilized where appropriate.

Results: Pooled data from the 14 studies (1,413 pts) that reported associated neurapraxias at presentation in sufficient detail revealed an overall incidence of 13% (190 pts) with the anterior interosseous nerve (AIN) being the most commonly involved (61/190). The next most commonly involved was the radial nerve 29% (56/190) of the time. Flynn's supracondylar rating system was next used in order to compare various forms of treatment. Pooled data from 12 studies (641 pts) comparing closed reduction and casting vs CRPP revealed a 2.4 times higher risk (p<0.001) of fair or poor results with closed reduction and casting as definitive treatment. Pooled data from 14 studies (743 pts) comparing traction treatment vs CRPP revealed a 1.6 times higher risk (p<0.025) of fair or poor results with traction as definitive treatment.

Discussion & Conclusion: Our meta-analysis demonstrates that AIN neurapraxia is the most common nerve injury noted at the time of initial presentation of displaced supracondylar fractures. CRPP has also been reaffirmed as the optimal treatment for displaced supracondylar humeral fractures.