Fri., 10/15/10 Knee, Tibia & Pediatrics, Paper #63, 4:44 pm OTA-2010
Delay in Surgery for Displaced Supracondylar Humeral Fracture: Does It Matter? (FDA=Non-U.S. research conducted within guidelines of my country)
Gunasekaran Kumar, FRCS; Antoni Otto, MBBS; Alfie Bass, FRCS;
Royal Liverpool Children’s Hospital, Alder Hey Children's NHS Foundation Trust,
Liverpool, United Kingdom
Background/Purpose: The purpose of this study was to assess association between time from injury to surgery and any perioperative complications. With literature supporting both operating on these fractures as early as possible and also delaying surgery until the next day, we reviewed our cohort of patients to ascertain whether there was a need for early surgery. There is also evidence for significant increase in complications in surgeries performed late in the night.
Methods: Between April 2005 and Sept 2008, 81 consecutive uncomplicated extension-type supracondylar elbow fractures requiring surgery were identified. Case notes and Meditech data were reviewed. Data collected included time of injury, time of surgery, senior surgeon present at surgery, open or closed reduction of fracture, perioperative complications including infections, reoperation rate, residual stiffness, and neurovascular injuries. Odds ratio was calculated for open reduction based on a cut-off of 24 hours since injury.
Results: Of the 81 fractures, 69 had surgery <24 hours and 12 had surgery >24 hours. All had either closed or open reduction and crossed Kirschner-wire fixation. 15 fractures required open reduction, 10 <24 hours and 5 >24 hours. There was no difference with respect to the grade of surgeon present. All patients were followed for at least 12 weeks. Two with closed reduction required surgery for redisplacement (initial surgery at 5 hours and 19 hours). One had refracture at 2 months after surgery following a significant fall. Odds ratio of open reduction of fracture if surgery was delayed beyond 24 hours was 4.2; 95% confidence interval, 1.2 to 16. There were 4 cases of superficial pin-site infection treated with oral antibiotics without sequelae. None of the patients required further surgery for stiffness of elbow.
Discussion: Displaced supracondylar fractures in children are a relatively common injury. Our institute is a tertiary pediatric referral center with a limited number of dedicated trauma lists. Hence, these injuries often are operated in the emergency theater in the middle of the night. Our data show that delaying surgery beyond 24 hours after injury increased the risk of open reduction of the fracture fourfold. However, there was no increased incidence of infection or any other complications. Limitations of our study include retrospective study, and the small number of open reductions. We did not assess the surgical time, number of attempts at closed reduction, or length of hospital stay. In spite of these limitations, there is a good basis for leaving uncomplicated supracondylar elbow fractures in children overnight provided surgery is performed within 24 hours of injury.
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.