Session II - Pediatrics/Spine

Displaced Supracondylar Humeral Fractures in Children: Does the Timing of Surgery Make a Difference?

Charles T. Mehlman, DO, MPH; William M. Strub, BA; Alvin H. Crawford, MD; Dennis R. Roy, MD; Eric J. Wall, MD, Children's Hospital Medical Center, Cincinnati, OH

Introduction: The purpose of this study was to determine whether the timing of surgical intervention for displaced supracondylar humeral fractures was associated with an increased risk of perioperative complications.

Methods: A group of 146 patients whose fractures were surgically treated greater than 8 hours after injury [Avg 23 hrs] was compared to another group of 52 patients treated less than 8 hours after injury [Avg 5 hrs]. Using logistic regression & Fisher's exact test, these groups were retrospectively analyzed with regard to (1) conversion from closed to open reduction, (2) infection, (3) iatrogenic nerve injury, & (4) compartment syndrome. Pulseless and open injuries were excluded.

Results: After controlling for age, sex, and fracture severity, NO SIGNIFICANT DIFFERENCE between the two groups could be identified concerning (1) conversion from closed to open reduction [p=0.56], (2) infection [p=0.12], or (3) iatrogenic nerve injury [p=0.72]. No compartment syndromes occurred in either group. Power calculation revealed that our study had > 80% power.

Discussion and Conclusion: In our study we were unable to demonstrate a significant difference between the early and delayed groups concerning these specific perioperative complications. This finding runs contrary to traditional opinion concerning management of these injuries. We conclude that operative treatment of closed and adequately perfused displaced supracondylar humeral fractures can be safely delayed when deemed appropriate by the treating surgeon.