They would then be admitted and taken to the OR for definitive management. Prior to 2012, per surgeon preference, patients with displaced supracondylar humerus fractures were treated with closed reduction and splinting under conscious sedation in the ED. The initial management of patients varied at our institution. Alignment is considered: (a) normal if the line intersects the capitellum and (b) abnormal if it does not. 28Įvaluation of elbow alignment using the anterior humeral line drawn along the anterior aspect of the humeral shaft on a lateral radiograph. 1a) and abnormal if it did not intersect the capitellum ( Fig. The anterior humeral line was considered normal if a line drawn along the anterior aspect of the humeral shaft intersected the capitellum on the lateral radiograph ( Fig. 26, 27 The anterior humeral line was evaluated on lateral radiographs. Baumann’s angle, the intersection of a line drawn along the axis of the humeral shaft and a line drawn through the physis of the lateral condyle of the humerus was measured on anteroposterior radiographs. Length of stay was based on the time between inpatient admission and inpatient discharge.įractures were assessed radiographically post-reduction and during the follow-up period. Electronic medical records and radiographs were retrospectively reviewed to determine demographic information, fracture classification, hospital time course, neurovascular status and radiographic outcome data. Departmental databases and billing records from a single institution were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM ) code 812.41 for closed supracondylar fracture of humerus. The purpose of this study was to investigate if there are differences in outcomes or complications between these two management methods.įollowing Institutional Review Board approval, 157 patients aged one to ten years who presented with a supracondylar humerus fracture Gartland type II or type III between 01 January 2008 and 31 December 2015 and complete ED records were identified. Since 2012, our protocol transitioned to in situ splinting in the ED followed by hospital admission until closed reduction and pinning are attempted solely in the OR. Prior to 2012, patients presenting to our institution with a displaced supracondylar humerus fracture usually underwent a closed reduction in the ED prior to definitive management. 9, 21- 25 No studies, however, have specifically compared the outcomes associated with closed reduction performed in the emergency department (ED) versus in situ splinting and definitive management in the OR. 4, 5, 18- 20 Multiple attempts at reduction may increase the risk of neuropraxia, elbow stiffness, myositis ossificans and anaesthetic complication. 1, 14- 17 Many studies have investigated the demographics, risk factors and complications associated with this treatment modality. 10- 13 The most common operative treatment for displaced supracondylar fractures is closed reduction followed by percutaneous pinning. For vascularly intact supracondylar fractures, a delay in operative management post-injury can be tolerated and does not affect perioperative complications or the need for open reduction. Immediate reduction in the operating room (OR) and possible surgical treatment is indicated for supracondylar humerus fractures with vascular compromise. Type III and IV fractures almost always need surgery. Finally, Gartland type IV fractures are defined by multidirectional instability. Gartland type III fractures are characterized by a displaced supracondylar fracture that lacks an intact cortex. A type II fracture is > 2 mm displaced with an intact posterior cortex and may benefit from surgical management depending on the amount of displacement. 1, 6- 8 A minimally displaced, or a type I, supracondylar fracture is typically treated with casting alone. Supracondylar humerus fractures are usually classified according to the modified Gartland classification system. 2- 5 Although some studies report a slight male preponderance, recent literature has noted equivalent incidence rates between male and female children. 1 They occur with a reported incidence rate of 20.7/100 000 and at an average six years of age, with extension type occurring in over 90% of cases. Supracondylar humerus fractures are the most common elbow fracture in children.
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