Sat., 10/15/11 Peds, Ger, Hip, Femur & IP, Paper #69, 10:17 am OTA-2011
Pediatric Type 2 Supracondylar Humerus Fractures: Does Time to Surgery Matter
A. Noelle Larson, MD1; Sumeet Garg, MD2; Amanda L. Weller, MD3;
Nicholas D. Fletcher, MD4; Jonathan R. Schiller, MD5; Michael Kwon, MD6;
Lawson A.B. Copley, MD7; Christine A. Ho, MD7;
1University of Minnesota, Minneapolis, Minnesota, USA;
2Denver Children’s Hospital, Denver, Colorado, USA;
3University of Texas Southwestern, Dallas, Texas, USA;
4Emory University, Atlanta, Georgia, USA;
5Brown University, Providence, Rhode Island, USA;
6Texas Scottish Rite Hospital for Children,
7Children’s Medical Center, Dallas, Texas, USA
Purpose: Due to changing referral patterns, increasing numbers of pediatric supracondylar humerus fractures are treated at tertiary centers. To expedite patient flow, type 2 fractures are sometimes pinned in a delayed fashion or in an outpatient setting. We hypothesized that delay in surgical treatment of Gartland type 2 supracondylar humerus fractures would not affect the generally excellent outcomes following closed reduction and percutaneous pinning.
Methods: We performed a retrospective review of a consecutive series of 1297 supracondylar fractures treated operatively at a tertiary referral center over 4 years. 31% (399 fractures) were Gartland type 2 fractures. Mean patient age in the type 2 group was 5 years (range, 1-15 years). 48% were pinned within 24 hours, 25% pinned from 1 to 5 days, and 27% pinned 5 days or more after the injury.
Results: 16 patients (4%) sustained a complication, but there was no association between complications and time to surgery. There were no compartment syndromes, vascular injuries, or permanent nerve injuries. Three patients sustained nerve injuries. All underwent surgery within 24 hours of injury. One patient developed an ulnar motor and sensory nerve palsy after fixation with crossed Kirschner wires. This resolved by 7 weeks postoperatively. One patient presented with an anterior interosseous nerve palsy that resolved at 7 weeks and 1 with a posterior interosseous nerve palsy, which resolved at 8 weeks postoperatively. Other complications included physical therapy referral for stiffness (3), pin-site infection (2 treated with oral antibiotics, 4 treated with surgical irrigation and débridement), refracture (2), and loss of fixation or broken hardware (2).
Conclusions: Satisfactory outcomes are possible even with delayed treatment of type 2 supracondylar humerus fractures. Delay in surgery did not result in increased complications following closed reduction and percutaneous pinning of type 2 supracondylar humerus fractures in children. Further prospective work is necessary to see if operative time or techniques differ or if there are subtle functional benefits with emergent treatment of type 2 supracondylar humerus fractures.
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• 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.