EPIDEMIOLOGY AND TIME-RELATED PATTERNS OF PEDIATRIC SUPRACONDYLAR HUMERUS FRACTURES REQUIRING SURGERY

Öz

Objective: Supracondylar humerus fractures are common injuries in childhood and often require surgery. Our aim is to determine whether there is a relationship between supracondylar humerus fractures and their subtypes and temporal characteristics (seasonal/monthly/weekdayweekend/ school time). Material and Methods: In this single-center, retrospective clinical observational study, patients who presented to our hospital between January 2011 and December 2018 and underwent surgical treatment for pediatric supracondylar humerus fractures were examined. Demographic data, fracture type, the month and season in which the fracture occurred, whether fractures during the school term occurred during or outside of school hours, and weekday-weekend information were obtained from the records and analyzed. Results: A total of 186 patients were included in the study (mean age 7.1±3.2, 67.2% male). Sixty-eight (36.6%) fractures occurred in the summer, 61 (32.8%) in the fall, 41 (22%) in the spring, and 16 (8.6%) in the winter. The highest number of patients presented in July, August, and September (25 patients each, 13.4%), while the lowest number presented in February (2 patients, 1.1%). One hundred twenty-five (67.2%) patients were admitted on weekdays and 61 (32.8%) on weekends. Of the patients who admitted on weekdays, 50 (40%) required open surgery, while 35 (57.4%) of those who were admitted on weekends required open surgery. The difference was found to be statistically significant (p=0.026). Seventy-four (50%) of school-aged children presented during the school term and twenty-two (29.7%) of these patients presented during school hours. Conclusion: A majority of supracondylar humerus fractures requiring surgery occur during the summer and fall seasons. During the school term, most fractures occur outside school hours. Open surgery was required significantly more often for fractures that occurred on weekends than for those that occurred on weekdays.

Anahtar Kelimeler

• Elbow
• surgical traumatology
• humeral fractures

Çocuklarda Cerrahi Tedavi Edilen Suprakondiler Humerus Kırıklarının Epidemiyolojik ve Zamansal Özellikleri

Öz

Amaç: Suprakondiler humerus kırıkları çocukluk çağında sık görülen ve sıklıkla cerrahi gerektiren yaralanmalardır. Amacımız suprakondiler humerus kırıkları ve bu kırıkların alt tipleri ile temporal özellikler (mevsimsel/aysal/hafta içisonu/ okul zamanı) arasında herhangi bir ilişki olup olmadığını belirlemektir. Gereç ve Yöntemler: Tek merkezli, retrospektif klinik gözlemsel çalışmada Ocak 2011- Aralık 2018 arasında hastanemizde başvuran ve cerrahi tedavi edilmiş pediatrik suprakondiler humerus kırığı olan hastalar incelendi. Demografik veriler, kırık tipi, hangi ayda ve hangi mevsimde gerçekleştiği, okul dönemindeki kırıkların okul saatinde veya dışında başvurduğu ve hafta içi-hafta sonu bilgisi kayıtlardan elde edildi ve analiz edildi. Bulgular: Çalışmaya toplam 186 hasta dahil edildi (ort. yaş 7,11±3,2, %67,2 erkek). Kırıkların 68’i (%36,6) yaz mevsiminde, 61’i (%32,8) sonbahar mevsiminde, 41’i (%22) ilkbahar mevsiminde, 16’sı (%8,6) ise kış mevsiminde başvurdu. En çok hastanın Temmuz, Ağustos ve Eylül aylarında (25’er hasta, %13,4), en az hastanın ise Şubat ayında (2 hasta, %1,1) başvurduğu gözlendi. Kırıkların 125’i (%67,2) hafta içi, 61’i ise (%32,8) hafta sonu başvurdu. Hafta içi başvuran hastaların 50’si (%40), hafta sonu başvuranların ise 35’i (%57,4) açık cerrahiye gereksinim duydu. Aradaki fark istatistiksel olarak anlamlı bulundu (p=0.026). Okul çağındaki çocukların 74’ü (%50) okulun açık olduğu dönemlerinde başvurdu. Bu hastaların 22’si (%29,7) okulun açık olduğu saatlerde başvurdu. Sonuç: Cerrahi gerektiren suprakondiler humerus kırıklarının önemli bir kısmı yaz ve sonbahar mevsimlerinde başvurmaktadır. Okulların açık olduğu dönemde kırıkların çoğunluğu okulların kapalı olduğu saatlerde başvurmuştur. Haftasonu başvuran kırıklarda açık cerrahi gereksinimi hafta içi başvuranlara göre anlamlı olarak daha fazla olmuştur.

Anahtar Kelimeler

• Dirsek
• cerrahi travmatoloji
• humerus kırıkları

Kaynakça

1. Hope N, Varacallo MA. Supracondylar Humerus Fractures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Accessed date: 10 September 2025: https://www.ncbi.nlm.nih.gov/books/ NBK560933/
2. Ausó-Pérez JR, Rodríguez-Blanes GM. Comprehensive analysis of pediatric supracondylar fractures in the emergency department: A single center experience. Bull Emerg Trauma. 2020;8(3):142-147.
3. Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fracture in children: Analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci. 2001;6(4):312-315.
4. Campbell CC, Waters PM, Emans JB, Kasser JR, Millis MB. Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop. 1995;15(1):47-52.
5. Duffy S, Flannery O, Gelfer Y, Monsell F. Overview of the contemporary management of supracondylar humeral fractures in children. Eur J Orthop Surg Traumatol. 2021;31(5):871-881.
6. Hahn SG, Schuller A, Pichler L, Hohensteiner A, et al. Complications and outcomes of surgically treated pediatric supracondylar humerus fractures. Children (Basel). 2024;11(7):791.
7. Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959;109(2):145-154.
8. Leitch KK, Kay RM, Femino JD, Tolo VT, Storer SK, Skaggs DL. Treatment of multidirectionally unstable supracondylar humeral fractures in children: A modified Gartland type-IV fracture. J Bone Joint Surg Am. 2006;88(5):980-985.

9. Schultz RJ, Amaral JZ, Bridges CS, et al. Gartland classification concordance of supracondylar fractures among pediatric emergency medicine physicians, radiologists, and orthopedic surgeons. Pediatr Radiol. 2024;54(7):1180-1186.
10. Ozbay H, Adanır O, Mraja HM. Effect of weather conditions on the pediatric supracondylar humerus fracture incidence. Cureus. 2022;14(11):e31558.
11. McRae B, Nusem I. Temporal characteristics of paediatric supracondylar humerus fractures. Trauma. 2018;20(3):208-216.
12. Steinman S, Bastrom TP, Newton PO, Mubarak SJ. Beware of ulnar nerve entrapment in flexion-type supracondylar humerus fractures. J Child Orthop. 2007;1(3):177-180.
13. Wilkins KE. Changing patterns in the management of fractures in children. Clin Orthop Relat Res. 1991;(264):136-155.
14. Alton TB, Werner SE, Gee AO. Classifications in brief: The Gartland classification of supracondylar humerus fractures. Clin Orthop Relat Res. 2015;473(2):738-741.
15. Coupal S, Lukas K, Plint A, et al. Management of Gartland type I supracondylar fractures: A systematic review. Front Pediatr. 2022;10:863985.
16. Booker M, Sumandea F, Pandya N, Swarup I. Nonoperative management of Gartland type II supracondylar humeral fractures: A comprehensive review. Curr Rev Musculoskelet Med. 2025;18(2):48-53.
17. Zhu D, Wen Y, Wang Q, Son B, Feng W. Conservative versus surgical treatment of Gartland type II supracondylar humeral fractures in children. J Pediatr Orthop B. 2024;33(6):568-573.
18. Barik S, Garg V, Sinha SK, Chaudhary S, Kandwal P, Singh V. A meta-analysis on comparison of open vs closed reduction of Gartland type III supracondylar humerus fractures in children. Acta Chir Orthop Traumatol Cech. 2023;90(3):198-205.
19. Ersan O, Gonen E, İlhan RD, Boysan E, Ates Y. Comparison of anterior and lateral approaches in the treatment of extension-type supracondylar humerus fractures in children. J Pediatr Orthop B. 2012;21(2):121-126.
20. Vaquero-Picado A, González-Morán G, Moraleda L. Management of supracondylar fractures of the humerus in children. EFORT Open Rev. 2018;3(10):526-540.
21. Cake A, Shpuza A, Mucaj R, Cela D. Epidemiology and seasonal patterns of paediatric supracondylar humeral fractures in Albania. Int J Curr Res Multidiscip. 2023;8(3):47-50.