Immobilization after pediatric supracondylar humerus fracture surgery: Cast or splint?

Abstract

Objective: While surgical treatment is the most accepted treatment method for displaced supracondylar humerus fractures in children, there is little data about immobilization method after surgery. The aim of the study is to determine whether there is any difference in preventing loss of reduction between long-arm cast and long-arm splint following pediatric supracondylar humerus fracture surgery.

Patients and Methods: We conducted a retrospective analysis of pediatric patients with supracondylar humerus fractures treated operatively between 2012 and 2019 at a university hospital. According to Skaggs criteria, early postoperative and 3rd-week follow-up X-rays were evaluated for the loss of reduction (LOR). Postoperative immobilization method; splint or cast was compared in the context of LOR.

Results: Cast immobilization was found to be superior in preventing LOR in the first three weeks postoperatively (p˂0.05). There was no significant difference for other factors like fracture configuration, patient age and surgical technique.

Conclusion: Cast immobilization is superior to splint immobilization in preventing radiologic LOR after pediatric supracondylar humerus fracture surgery however, clinical relevance of this conclusion is yet to be proved. Keywords: Supracondylar humerus fracture, Postoperative immobilization, Loss of reduction

Keywords

• Supracondylar humerus fracture
• Postoperative immobilization
• Loss of reduction

References

1. [1] Otsuka NY, Kasser JR. Supracondylar fractures of the humerus in children. J Am Acad Orthop Surg 1997;5:19-26. doi: 10.5435/00124.635.199701000-00003
2. [2] Shrader MW. Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthop Clin North Am 2008 ;39:163- 71. doi: 10.1016/j.ocl.2007.12.005.
3. [3] Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J Pediatr Orthop 1998;18:38-42. PMID: 9449099
4. [4] Pennock AT, Charles M, Moor M, et al. Potential causes of loss of reduction in supracondylar humerus fractures. J Pediatr Orthop 2014;34:691-7. doi: 10.1097/BPO.000.000.0000000154.
5. [5] Sankar WN, Hebela NM, Skaggs DL, at al. Loss of pin fixation in displaced supracondylar humeral fractures in children: causes and prevention. J Bone Joint Surg Am 2007;89:713- 7. doi: 10.2106/JBJS.F.00076
6. [6] Lewine E, Kim JM, Miller PE, et al. Closed versus open supracondylar fractures of the humerus in children: a comparison of clinical and radiographic presentation and results. J Pediatr Orthop 2018;38:77-81. doi: 10.1097/ BPO.000.000.0000000769.
7. [7] Balasubramanian Balakumar VM. A retrospective analysis of loss of reduction in operated supracondylar humerus fractures. Indian J Orthop 2012;46:690-7. doi:10.4103/0019- 5413.104219.
8. [8] Bahk MS, Srikumaran U, Ain MC, et al. Patterns of pediatric supracondylar humerus fractures. J Pediatr Orthop 2008;28:493-9. doi:10.1097/BPO.0b013e31817bb860

9. [9] Leitch K, Kay R, Femino J, et al. Treatment of multidirectionally unstable supracondylar humeral fractures in children: a modified Gartland type-IV fracture. JBJS 88:980-985 J Bone Joint Surg Am. 2006 May;88(5):980-5. doi: 10.2106/ JBJS.D.02956.
10. [10] Bouton D, Ho CA, Abzug J, et al. The difficult supracondylar humerus fracture: flexion-type injuries. Instr Course Lect 2016;65:371-7. PMID: 27049205
11. [11] Kocher MS, Kasser JR, Waters PM, et al. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children: a randomized clinical trial. J Bone Joint Surg Am 2007 ;89:706- 12. doi: 10.2106/JBJS.F.00379.
12. [12] Hosseinzadeh P, Talwalkar VR Compartment syndrome in children: diagnosis and management. Am J Orthop (Belle Mead NJ). 2016;45:19-22. PMID: 26761913
13. [13] Mulpuri K, Wilkins K The treatment of displaced supracondylar humerus fractures: evidence-based guideline. J Pediatr Orthop. 2012;32 Suppl 2:S143-52. doi: 10.1097/ BPO.0b013e318255b17b.
14. [14] Baratz M, Micucci C, Sangimino M Pediatric supracondylar humerus fractures. Hand Clin 2006;22:69-75. doi: 10.1016/j. hcl.2005.11.002.
15. [15] Kim TJ, Sponseller PD. Pediatric supracondylar humerus fractures. J Hand Surg Am 2014;39:2308-11; quiz 2311. doi: 10.1016/j.jhsa.2014.07.005
16. [16] McKeon KE, O’Donnell JC, Bashyal R, et al. Immobilization after pinning of supracondylar distal humerus fractures in children: use of the A-frame cast. J Pediatr Orthop 2012;3:e1- 5. doi: 10.1097/BPO.0b013e31823db1b4.
17. [17] Azzolin L, Angelliaume A, Harper L, et al. Optimal postoperative immobilisation for supracondylar humeral fractures. Orthop Traumatol Surg Res 2018;104:645-649. doi: 10.1016/j.otsr.2018.03.015.
18. [18] Reisoglu A, Kazimoglu C, Hanay E, et al. Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures? Acta Orthop Traumatol Turc 2017 ;51:34-38. doi: 10.1016/j.aott.2016.11.003.
19. [19] Skaggs DL, Cluck MW, Mostofi A, et al. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am 2004;86:702-7. doi: 10.2106/00004.623.200404000-00006.
20. [20] Zusman N, Barney NA, Halsey MF, et al. Utility of follow-up radiographs after pin removal in supracondylar humerus fractures: A retrospective cohort study. J Am Acad Orthop Surg 2020;28:e71-e76. doi: 10.5435/JAAOS-D-18-00415.
21. [21] Thompson R, Hubbard E, Elliott M, et al. Is less more? Assessing the utility of early clinical and radiographic follow-up for operative supracondylar humerus fractures. J Child Orthop 2018;12:502-8. doi: 10.1302/1863-2548.12.180054
22. [22] Tuomilehto N, Kivisaari R, Sommarhem A, et al. Outcome after pin fixation of supracondylar humerus fractures in children: postoperative radiographic examinations are unnecessary: A retrospective study of 252 Gartland-III and 12 flexion-type supracondylar humerus fractures. Acta Orthop 2017 ;88:109-15. doi: 10.1080/17453.674.2016.1250058.
23. [23] Aarons CE, Iobst C, Chan DB, et al. Repair of supracondylar humerus fractures in children: does pin spread matter? J Pediatr Orthop B 2012;21:499-504. doi: 10.1097/ BPB.0b013e32835875ef.