Sat., 10/6/12 Pediatric Fractures, PAPER #108, 3:17 pm OTA-2012
Epidemiology of Vascular Complications in Supracondylar Humerus Fractures in the United States
Joshua Roehrich, MD1; Charles T. Mehlman, DO, MPH2, Jun Ying, PhD1;
1University of Cincinnati, Cincinnati, Ohio, USA;
2Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
Background/Purpose: Supracondylar humeral fractures are the most common pediatric elbow fracture and may be associated with vascular complications. The purpose of our research was to analyze the incidence of vascular complications associated with pediatric supracondylar humeral fractures in the United States using the KID (Kids’ Inpatient Database from the Healthcare Cost and Utilization Project) from1997 thru 2009. Among patients who sustain supracondylar humeral fractures in the United States, the incidence rates of compartment syndrome and arterial injury are 0.32% and 0.73%, respectively.
Methods: The three primary outcome measures that we defined as vascular complications include: compartment syndrome, arterial injury, and Volkmann’s ischemic contracture. Additionally we searched for potential risk factors associated with vascular complications, including presence of concomitant fractures, concomitant nerve injury, age, gender, payer status, etc. The appropriate ICD-9 codes were used to identify variables of interest within the KID database. Mulivariate analysis of KID datasets and multiple stepwise logistic regression were used for data analysis.
Results: Analysis of the KID database from 1997-2009 revealed a total of 48,936 patients with a diagnosis of a supracondylar humeral fracture after weighting the data to obtain a national estimate. The mean age of patients was 6 years old. Among the 48,936 patients with a supracondylar humeral fracture, 158 were diagnosed with compartment syndrome and 358 sustained an arterial injury, yielding incidence rates of 0.32% and 0.73%, respectively. The incidence of compartment syndrome was 1.73% (44 of 2533) in patients with an associated forearm fracture and 2.87% (41 of 1431) in patients with a concomitant nerve injury. The incidence of compartment syndrome increased to 3.4% (5 of 147) in patients with multiple injured nerves. The incidence of arterial injury in patients with a concomitant peripheral nerve injury was 6.78% (97 of 1431), 8.84% (13 of 147) when multiple nerves were injured, and 20% when the median nerve was injured. There were not enough patients with a diagnosis of Volkmann’s ischemic contracture to be included in our study.
Conclusion: Our large database study confirms what previous authors and many practitioners consider to be the case—supracondylar humeral fracture patients who have concomitant forearm fractures or nerve injury have a higher risk of vascular injury. Our study is also the first to report the national incidence of arterial injury (~30 children per year in the US) and compartment syndrome (~13 children per year in the US) in pediatric supracondylar humeral fracture patients.
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