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Retrospective analysis of the determining factors for open reduction in pediatric humerus supracondylar fractures: Are factors such as time until operation and surgeon's experience effective?

Year 2023, Volume: 7 Issue: 3, 254 - 258, 31.12.2023
https://doi.org/10.30565/medalanya.1396535

Abstract

Aim: indications for open surgery are very limited in supracondylar humerus fractures (SCHFs).
In our study, we aimed to examine whether the patient’s fracture type, waiting time of the patient before the operation, and the experience of the surgeon are effective on the treatment decision for open surgical method in our SCHF patients treated with open reduction.

Methods: A group of pediatric patients treated with open reduction for SCHF between the years of 2010 and 2022 were examined for our study. Trauma mechanism, type of fracture, time until operation, neurovascular injuries and years of experience of the surgeons were retrospectively reviewed.

Results: A total of 110 patients were included in the study. The mean age was 5.7 years. Nine patients were flexion-type SCHF. According to the Gartland classification, 19 patients were Type II and 82 patients were Type III. Ninety-four patients were operated in the first 24 hours, 16 patients were operated after 24 hours. There was no statistical correlation between the surgeons’ experience or time until operation and the type of the fractures. Patients with flexion type fractures were significantly older than the other patients.

Conclusion: Extension Type III fractures are often require open surgery regardless of the surgeon's experience and waiting time for surgery. Regardless of the surgeon's years of experience and the type of the fracture, some fractures cannot be treated with closed reduction and require open reduction.

References

  • 1. Boyd DW, Aronson DD. Supracondylar fractures of the humerus: a prospective study of percutaneous pinning. J Pediatr Orthop 1992;12:789–74. doi: 10.1097/01241398-199211000-00017.
  • 2. Carmichael KD, Joyner K. Quality of reduction versus timing of surgical intervention for pediatric supracondylar humerus fractures. Orthopedics 2006;29:628–32. doi: 10.3928/01477447-20060701-13. 
  • 3. Baratz M, Micucci C, Sangimino M. Pediatric supracondylar humerus fractures. Hand Clin. 2006;22(1):69-75. doi: 10.1016/j.hcl.2005.11.002. 
  • 4. Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am 2008;90:1121–32. doi: 10.2106/JBJS.G.01354. 
  • 5. Abzug JM, Herman MJ. Management of supracondylar humerus fractures in children: current concepts. J Am Acad Orthop Surg 2012;20:69–77. doi: 10.5435/JAAOS-20-02-069. 
  • 6. Edmonds EW, Roocroft JH, Mubarak SJ. Treatment of displaced pediatric supracondylar humerus fracture patterns requiring medial fixation: a reliable and safer cross-pinning technique. J Pediatr Orthop 2012;32:346–51. doi: 10.1097/BPO.0b013e318255e3b1.
  • 7. Skaggs DL, Sankar WN, Albrektson J, Vaishnav S, Choi PD, Kay RM. How safe is the operative treatment of Gartland type 2 supracondylar humerus fractures in children? J Pediatr Orthop. 2008;28(2):139-41. doi: 10.1097/BPO.0b013e3181653ac8.
  • 8. Ariyawatkul T, Eamsobhana P, Kaewpornsawan K. The necessity of fixation in Gartland type 2 supracondylar fracture of the distal humerus in children (modified Gartland type 2A and 2B). J Pediatr Orthop B. 2016;25(2):159-64. doi: 10.1097/BPB.0000000000000251.
  • 9. Reitman RD, Waters P, Millis M. Open reduction and internal fixation for supracondylar humerus fractures in children. J Pediatr Orthop 2001;21:157–61. PMID: 11242241
  • 10. Latario LD, Lubitz MG, Narain AS, Swart EF, Mortimer ES. Which pediatric supracondylar humerus fractures are high risk for conversion to open reduction?  J Pediatr Orthop B. 2023;32(6):569-74. doi: 10.1097/BPB.0000000000001042. 
  • 11. Uludağ A, Tosun HB, Aslan TT, Uludağ Ö, Gunay A. Comparison of Three Different Approaches in Pediatric Gartland Type 3 Supracondylar Humerus Fractures Treated With Cross-Pinning. Cureus. 2020;23;12(6):e8780. doi: 10.7759/cureus.8780.
  • 12. Carter CT, Bertrand SL, Cearley DM. Management of pediatric type III supracondylar humerus fractures in the United States: results of a national survey of pediatric orthopaedic surgeons. J Pediatr Orthop 2013;33:750–4. doi: 10.1097/BPO.0b013e31829f92f3.
  • 13. Cramer KE, Devito DP, Green NE. Comparison of closed reduction and percutaneous pinning versus open reduction and percutaneous pinning in displaced supracondylar fractures of the humerus in children. J Orthop Trauma. 1992;6:407–12. doi: 10.1097/00005131-199212000-00002.
  • 14. Danielsson L, Pettersson H. Open reduction and pin fixation of severely displaced supracondylar fractures of the humerus in children. Acta Orthop Scand. 1980;51:249–55. PMID: 7435182
  • 15. Hart GM, Wilson DW, Arden GP. The operative management of the difficult supracondylar fracture of the humerus in the child. Injury. 1977;9:30–4. doi: 10.1016/0020-1383(77)90046-8.
  • 16. Mehlman CT, Crawford AH, McMillion TL, et al. Operative treatment of supracondylar fractures of the humerus in children: the Cincinnati experience. Acta Orthop Belg. 1996;62 Suppl 1:41-50. PMID: 9084559
  • 17. Schmid T, Joeris A, Slongo T, Ahmad SS, Ziebarth K. Displaced supracondylar humeral fractures: influence of delay of surgery on the incidence of open reduction, complications and outcome. Arch Orthop Trauma Surg 2015;135:963–9. doi: 10.1007/s00402-015-2248-0.
  • 18. Silva M, Kazantsev M, Aceves Martin B, Delfosse EM. Pediatric supracondylar humerus fractures: is surgeon experience a surrogate for the need of open reduction? J Pediatr Orthop B. 2018;27(2):103-107. doi: 10.1097/BPB.0000000000000487.
  • 19. Ciftci S, Safali S, Ergin M, Özdemir A, Acar MA. Is methyl methacrylate fixator reliable for the treatment of gartland type IV supracondylar fractures? Niger J Clin Pract. 2023;26(10):1463-71. doi: 10.4103/njcp.njcp_15_23. 
  • 20. Guven MF, Kaynak G, Inan M, Caliskan G, Unlu HB, Kesmezacar H. Results of displaced supracondylar humerus fractures treated with open reduction and internal fixation after a mean 22.4 years of follow-up. J Shoulder Elbow Surg 2015;24:640–6. doi: 10.1016/j.jse.2014.12.010.
  • 21. Aslan A, Konya MN, Ozdemir A, Yorgancigil H, Maralcan G, Uysal E. Open reduction and pinning for the treatment of Gartland extension type III supracondylar humeral fractures in children. Strategies Trauma Limb Reconstr. 2014;9(2):79-88. doi: 10.1007/s11751-014-0198-7.
  • 22. Iyengar SR, Hoffinger SA, Townsend DR. Early versus delayed reduction and pinning of type III displaced supracondylar fractures of the humerus in children: a comparative study. J Orthop Trauma. 1999;13:51–5. doi: 10.1097/00005131-199901000-00012. 
  • 23. Leet AL, Frisancho J, Ebramzadeh E. Delayed treatment of type 3 supracondylar humerus fractures in children. J Pediatr Orthop. 2002;22:203–7. PMID: 11856931
  • 24. Mehlman CT, Strub WM, Roy DR, Wall EJ, Crawford AH. The effect of surgical timing on the perioperative complications of supracondylar humeral fractures in children. J Bone Joint Surg Am. 2001;83(3):323-7. doi: 10.2106/00004623-200103000-00002
  • 25. Walmsley PJ, Kelly MB, Robb JE, Annan IH, Porter DE. Delay increases the need for open reduction of type-III supracondylar fractures of the humerus. J Bone Joint Surg Br. 2006;88(4):528-30. doi: 10.1302/0301-620X.88B4.17491.

Pediatrik humerus suprakondiler kırıklarında açık redüksiyonu belirleyen faktörlerin retrospektif analizi: Operasyona kadar geçen süre ve cerrahın deneyimi gibi faktörler etkili midir?

Year 2023, Volume: 7 Issue: 3, 254 - 258, 31.12.2023
https://doi.org/10.30565/medalanya.1396535

Abstract

Amaç: Suprakondiler humerus kırıklarında (SKHK) açık cerrahi için kesin endikasyonlar çok sınırlıdır. Çalışmamızda açık redüksiyon ile tedavi edilen SKHK hastalarımızda, hastanın kırık tipi, operasyon öncesi hastanın bekleme süresi ve cerrahın deneyiminin açık cerrahi yöntem için tedavi kararında etkili olup olmadığını incelemeyi amaçladık.

Yöntem: Çalışmamız için 2010-2022 yılları arasında SKHK nedeniyle açık redüksiyon ile tedavi edilen çocuk hasta grubu incelendi. Travma mekanizması, kırık tipi, operasyona kadar geçen süre, nörovasküler yaralanmalar ve cerrahların yıllara dayanan deneyim süreleri retrospektif olarak incelendi.

Bulgular: Çalışmaya toplam 110 hasta dahil edildi. Ortalama yaş 5.7 idi. 9 hasta fleksiyon tipi SKHK idi. Gartland sınıflamasına göre 19 hasta Tip II, 82 hasta Tip III idi. 94 hasta ilk 24 saatte, 16 hasta 24 saat sonra ameliyat edildi. Cerrahların deneyimi veya ameliyata kadar geçen süre ile kırık tipi arasında istatistiksel bir ilişki yoktu. Fleksiyon tipi kırığı olan hastalar diğer hastalardan anlamlı olarak daha ileri yaştaydı.

Sonuç: Cerrahın tecrübesi ve kırığın türü ne olursa olsun, bazı kırıklar kapalı redüksiyonla tedavi edilemez ve açık redüksiyon sonrası fikse edilirler. Özellikle ekstansiyon tipi Gartland Tip III kırıklar, cerrahın deneyimine ve ameliyat için bekleme süresine bakılmaksızın genellikle açık redüksiyon gerektirir.

References

  • 1. Boyd DW, Aronson DD. Supracondylar fractures of the humerus: a prospective study of percutaneous pinning. J Pediatr Orthop 1992;12:789–74. doi: 10.1097/01241398-199211000-00017.
  • 2. Carmichael KD, Joyner K. Quality of reduction versus timing of surgical intervention for pediatric supracondylar humerus fractures. Orthopedics 2006;29:628–32. doi: 10.3928/01477447-20060701-13. 
  • 3. Baratz M, Micucci C, Sangimino M. Pediatric supracondylar humerus fractures. Hand Clin. 2006;22(1):69-75. doi: 10.1016/j.hcl.2005.11.002. 
  • 4. Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am 2008;90:1121–32. doi: 10.2106/JBJS.G.01354. 
  • 5. Abzug JM, Herman MJ. Management of supracondylar humerus fractures in children: current concepts. J Am Acad Orthop Surg 2012;20:69–77. doi: 10.5435/JAAOS-20-02-069. 
  • 6. Edmonds EW, Roocroft JH, Mubarak SJ. Treatment of displaced pediatric supracondylar humerus fracture patterns requiring medial fixation: a reliable and safer cross-pinning technique. J Pediatr Orthop 2012;32:346–51. doi: 10.1097/BPO.0b013e318255e3b1.
  • 7. Skaggs DL, Sankar WN, Albrektson J, Vaishnav S, Choi PD, Kay RM. How safe is the operative treatment of Gartland type 2 supracondylar humerus fractures in children? J Pediatr Orthop. 2008;28(2):139-41. doi: 10.1097/BPO.0b013e3181653ac8.
  • 8. Ariyawatkul T, Eamsobhana P, Kaewpornsawan K. The necessity of fixation in Gartland type 2 supracondylar fracture of the distal humerus in children (modified Gartland type 2A and 2B). J Pediatr Orthop B. 2016;25(2):159-64. doi: 10.1097/BPB.0000000000000251.
  • 9. Reitman RD, Waters P, Millis M. Open reduction and internal fixation for supracondylar humerus fractures in children. J Pediatr Orthop 2001;21:157–61. PMID: 11242241
  • 10. Latario LD, Lubitz MG, Narain AS, Swart EF, Mortimer ES. Which pediatric supracondylar humerus fractures are high risk for conversion to open reduction?  J Pediatr Orthop B. 2023;32(6):569-74. doi: 10.1097/BPB.0000000000001042. 
  • 11. Uludağ A, Tosun HB, Aslan TT, Uludağ Ö, Gunay A. Comparison of Three Different Approaches in Pediatric Gartland Type 3 Supracondylar Humerus Fractures Treated With Cross-Pinning. Cureus. 2020;23;12(6):e8780. doi: 10.7759/cureus.8780.
  • 12. Carter CT, Bertrand SL, Cearley DM. Management of pediatric type III supracondylar humerus fractures in the United States: results of a national survey of pediatric orthopaedic surgeons. J Pediatr Orthop 2013;33:750–4. doi: 10.1097/BPO.0b013e31829f92f3.
  • 13. Cramer KE, Devito DP, Green NE. Comparison of closed reduction and percutaneous pinning versus open reduction and percutaneous pinning in displaced supracondylar fractures of the humerus in children. J Orthop Trauma. 1992;6:407–12. doi: 10.1097/00005131-199212000-00002.
  • 14. Danielsson L, Pettersson H. Open reduction and pin fixation of severely displaced supracondylar fractures of the humerus in children. Acta Orthop Scand. 1980;51:249–55. PMID: 7435182
  • 15. Hart GM, Wilson DW, Arden GP. The operative management of the difficult supracondylar fracture of the humerus in the child. Injury. 1977;9:30–4. doi: 10.1016/0020-1383(77)90046-8.
  • 16. Mehlman CT, Crawford AH, McMillion TL, et al. Operative treatment of supracondylar fractures of the humerus in children: the Cincinnati experience. Acta Orthop Belg. 1996;62 Suppl 1:41-50. PMID: 9084559
  • 17. Schmid T, Joeris A, Slongo T, Ahmad SS, Ziebarth K. Displaced supracondylar humeral fractures: influence of delay of surgery on the incidence of open reduction, complications and outcome. Arch Orthop Trauma Surg 2015;135:963–9. doi: 10.1007/s00402-015-2248-0.
  • 18. Silva M, Kazantsev M, Aceves Martin B, Delfosse EM. Pediatric supracondylar humerus fractures: is surgeon experience a surrogate for the need of open reduction? J Pediatr Orthop B. 2018;27(2):103-107. doi: 10.1097/BPB.0000000000000487.
  • 19. Ciftci S, Safali S, Ergin M, Özdemir A, Acar MA. Is methyl methacrylate fixator reliable for the treatment of gartland type IV supracondylar fractures? Niger J Clin Pract. 2023;26(10):1463-71. doi: 10.4103/njcp.njcp_15_23. 
  • 20. Guven MF, Kaynak G, Inan M, Caliskan G, Unlu HB, Kesmezacar H. Results of displaced supracondylar humerus fractures treated with open reduction and internal fixation after a mean 22.4 years of follow-up. J Shoulder Elbow Surg 2015;24:640–6. doi: 10.1016/j.jse.2014.12.010.
  • 21. Aslan A, Konya MN, Ozdemir A, Yorgancigil H, Maralcan G, Uysal E. Open reduction and pinning for the treatment of Gartland extension type III supracondylar humeral fractures in children. Strategies Trauma Limb Reconstr. 2014;9(2):79-88. doi: 10.1007/s11751-014-0198-7.
  • 22. Iyengar SR, Hoffinger SA, Townsend DR. Early versus delayed reduction and pinning of type III displaced supracondylar fractures of the humerus in children: a comparative study. J Orthop Trauma. 1999;13:51–5. doi: 10.1097/00005131-199901000-00012. 
  • 23. Leet AL, Frisancho J, Ebramzadeh E. Delayed treatment of type 3 supracondylar humerus fractures in children. J Pediatr Orthop. 2002;22:203–7. PMID: 11856931
  • 24. Mehlman CT, Strub WM, Roy DR, Wall EJ, Crawford AH. The effect of surgical timing on the perioperative complications of supracondylar humeral fractures in children. J Bone Joint Surg Am. 2001;83(3):323-7. doi: 10.2106/00004623-200103000-00002
  • 25. Walmsley PJ, Kelly MB, Robb JE, Annan IH, Porter DE. Delay increases the need for open reduction of type-III supracondylar fractures of the humerus. J Bone Joint Surg Br. 2006;88(4):528-30. doi: 10.1302/0301-620X.88B4.17491.
There are 25 citations in total.

Details

Primary Language English
Subjects Orthopaedics
Journal Section Research Article
Authors

Murat Taşcı 0000-0001-5391-7662

Muhammed Enes Karatas 0000-0003-0995-0953

Bahattin Kemah 0000-0002-4795-4309

Publication Date December 31, 2023
Submission Date November 29, 2023
Acceptance Date December 16, 2023
Published in Issue Year 2023 Volume: 7 Issue: 3

Cite

Vancouver Taşcı M, Karatas ME, Kemah B. Retrospective analysis of the determining factors for open reduction in pediatric humerus supracondylar fractures: Are factors such as time until operation and surgeon’s experience effective?. Acta Med. Alanya. 2023;7(3):254-8.

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