Clinical characteristics of severe supracondylar humerus fractures in children

Sumeet Garg, Amanda Weller, A. Noelle Larson, Nicholas D. Fletcher, Michael Kwon, Jonathan Schiller, Richard Browne, Lawson Copley, Christine Ho

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: The safety of delayed surgical treatment of severe supracondylar elbow fractures in children remains debated. No large studies have evaluated complications of injury and surgery evaluating only type 3 fractures. Our aim was to review the results of our experience treating children with severe supracondylar elbow fractures at various time points after injury. Methods: All children treated operatively for supracondylar humerus fractures from 2004 to 2007 at a single pediatric trauma center were identified. A total of 1296 children had operative treatment, of which 872 had type 3 fractures. Clinical records were reviewed to identify time to surgery from presentation at our institution. Patients were grouped into 4 cohorts [<6 h (n=325), 6 to 12 h (n=224), 12 to 24 h (n=295), and >24 h (n=28)]. Emergency, operative, inpatient, and outpatient records were reviewed to determine morbidity at presentation as well as operative and postoperative complications. Results: There was no difference in sex, age, or energy mechanism between children in the various time groups. An absent pulse was found in 54 children (6%) at presentation, of which only 5 ultimately required a vascular intervention. Nerve injury occurred in 105 patients (12%). Use of a medial entry pin was not associated with ulnar nerve injury. Increased time from presentation to surgery was not associated with increased morbidity from the injury or treatment complications. In contrast, there was a trend to steady decrease in morbidity and complication rates with increased time to surgery. Conclusions: This is the largest single-center study of severe supracondylar humerus fractures and describes rates of vascular compromise, nerve injury, infection, and other complications of these injuries. Most children with type 3 supracondylar humerus fractures can be treated safely in a delayed manner. Appropriate clinical judgment is imperative to optimize outcomes. Level of evidence: Level III - retrospective comparative study.

Original languageEnglish (US)
Pages (from-to)34-39
Number of pages6
JournalJournal of Pediatric Orthopaedics
Volume34
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Humerus
Wounds and Injuries
Elbow
Morbidity
Blood Vessels
Ulnar Nerve
Trauma Centers
Sex Characteristics
Inpatients
Emergencies
Outpatients
Therapeutics
Retrospective Studies
Pediatrics
Safety
Infection

Keywords

  • Complication
  • Delay
  • Supracondylar humerus fracture
  • Surgery
  • Type 3

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)
  • Orthopedics and Sports Medicine

Cite this

Garg, S., Weller, A., Noelle Larson, A., Fletcher, N. D., Kwon, M., Schiller, J., ... Ho, C. (2014). Clinical characteristics of severe supracondylar humerus fractures in children. Journal of Pediatric Orthopaedics, 34(1), 34-39. https://doi.org/10.1097/BPO.0b013e31829c0046

Clinical characteristics of severe supracondylar humerus fractures in children. / Garg, Sumeet; Weller, Amanda; Noelle Larson, A.; Fletcher, Nicholas D.; Kwon, Michael; Schiller, Jonathan; Browne, Richard; Copley, Lawson; Ho, Christine.

In: Journal of Pediatric Orthopaedics, Vol. 34, No. 1, 01.2014, p. 34-39.

Research output: Contribution to journalArticle

Garg, S, Weller, A, Noelle Larson, A, Fletcher, ND, Kwon, M, Schiller, J, Browne, R, Copley, L & Ho, C 2014, 'Clinical characteristics of severe supracondylar humerus fractures in children', Journal of Pediatric Orthopaedics, vol. 34, no. 1, pp. 34-39. https://doi.org/10.1097/BPO.0b013e31829c0046
Garg, Sumeet ; Weller, Amanda ; Noelle Larson, A. ; Fletcher, Nicholas D. ; Kwon, Michael ; Schiller, Jonathan ; Browne, Richard ; Copley, Lawson ; Ho, Christine. / Clinical characteristics of severe supracondylar humerus fractures in children. In: Journal of Pediatric Orthopaedics. 2014 ; Vol. 34, No. 1. pp. 34-39.
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abstract = "Background: The safety of delayed surgical treatment of severe supracondylar elbow fractures in children remains debated. No large studies have evaluated complications of injury and surgery evaluating only type 3 fractures. Our aim was to review the results of our experience treating children with severe supracondylar elbow fractures at various time points after injury. Methods: All children treated operatively for supracondylar humerus fractures from 2004 to 2007 at a single pediatric trauma center were identified. A total of 1296 children had operative treatment, of which 872 had type 3 fractures. Clinical records were reviewed to identify time to surgery from presentation at our institution. Patients were grouped into 4 cohorts [<6 h (n=325), 6 to 12 h (n=224), 12 to 24 h (n=295), and >24 h (n=28)]. Emergency, operative, inpatient, and outpatient records were reviewed to determine morbidity at presentation as well as operative and postoperative complications. Results: There was no difference in sex, age, or energy mechanism between children in the various time groups. An absent pulse was found in 54 children (6{\%}) at presentation, of which only 5 ultimately required a vascular intervention. Nerve injury occurred in 105 patients (12{\%}). Use of a medial entry pin was not associated with ulnar nerve injury. Increased time from presentation to surgery was not associated with increased morbidity from the injury or treatment complications. In contrast, there was a trend to steady decrease in morbidity and complication rates with increased time to surgery. Conclusions: This is the largest single-center study of severe supracondylar humerus fractures and describes rates of vascular compromise, nerve injury, infection, and other complications of these injuries. Most children with type 3 supracondylar humerus fractures can be treated safely in a delayed manner. Appropriate clinical judgment is imperative to optimize outcomes. Level of evidence: Level III - retrospective comparative study.",
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