Session VI - Pediatrics
Does Delay Increase the Need for Open Surgery in Type-III Supracondylar Fractures of the Humerus?
Background: Supracondylar fractures of the humerus represent the second most common childhood fracture. Traditionally these injuries have been treated as emergency cases and operated on at the earliest opportunity. Following recent reports in the literature, we undertook a study to examine whether surgical timing affected the need for open reduction or perioperative complications in the type III injuries.
Methods: Between August 1995 and August 2004, 534 patients presented to or were referred to our unit with a supracondylar fracture of the humerus. From this cohort, those with closed type III injuries without vascular compromise were selected (171 patients). These were divided into 2 groupsthose undergoing surgery less than 8 hours from presentation (126 patients) and those undergoing surgery more than 8 hours from presentation (45 patients). Both groups had demographic data collected, along with data on length of surgical procedure, type of fixation, and any early or late perioperative complications.
Results: Girls appear to be overrepresented in the delayed group; otherwise there were no differences in demographic or clinical profiles, including preoperative neurology or compartment syndrome, between the groups. Both groups had a single wound infection and no difference in perioperative complications. The major differences between the two groups were: (1) the delayed group were more likely to undergo open reduction (33.3% versus 11.2%, P<0.05) and (2) the mean length of the surgical procedure was increased (105.1 minutes versus 69.2 minutes, P<0.05).
Conclusion: Delay in treatment of the type III supracondylar fractures is associated with a need for open reduction and a lengthy procedure. We would recommend treating these injuries at the earliest opportunity.