Increased severity of type III supracondylar humerus fractures in the preteen population

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

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BACKGROUND:: Supracondylar humerus fractures are the most common operative fractures in children; however, no studies describe the older child with this injury. The purpose of this study was to compare Gartland type III supracondylar humerus fractures in children older than 8 years of age with those in younger children than age 8. We hypothesized that there would be more complications in older children, reflecting a higher-energy injury mechanism. METHODS:: A retrospective chart review of supracondylar humerus fractures managed at a single level I pediatric trauma institution from 2004 to 2007 was performed. Patients with type III fractures were divided into groups based on age at presentation greater or less than 8. Baseline demographics, fracture characteristics, mechanism of injury, operative technique, and complications were analyzed. RESULTS:: A consecutive series of 1297 pediatric patients with surgically treated supracondylar humerus fractures was retrospectively reviewed including 873 (67.3%) type III fractures. Of those, 160 (18.3%) patients were older than age 8 at time of injury. Older children were more likely to have fractures from high-energy mechanisms (45.1% vs. 28.7%, P<0.001) and more open fracture (3.8% vs. 1.3%, P=0.0097). There was no difference in preoperative or iatrogenic neuropraxias between groups. There was a shorter delay between presentation and surgery in older children (mean, 217 vs. 451 min, P<0.0001). Three or more pins were used more often in older patients (61.8% in older children vs. 43.6% in younger children, P<0.0001). Major complications including reoperation, loss of fixation, or compartment syndrome were rare in both groups (1.1% in younger group vs. 0.6% in older group, P=1.000). There was a trend toward more pin site infections in older children (3.75% vs. 1.56%, P=0.071). Physical therapy was required nearly 4 times more frequently in older children for management of residual stiffness (20.0% vs. 5.7%, P<0.0001). CONCLUSIONS:: Children older than 8 years of age have a higher rate of open supracondylar humerus fractures, although nerve injury rates are similar. Surgeons placed more pins for fixation of fractures in older patients and elbow stiffness requiring physical therapy occurred more commonly after surgical intervention. EVIDENCE:: III Retrospective cohort.

Original languageEnglish (US)
Pages (from-to)567-572
Number of pages6
JournalJournal of Pediatric Orthopaedics
Volume32
Issue number6
DOIs
StatePublished - Sep 2012
Externally publishedYes

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Humerus
Population
Wounds and Injuries
Pediatrics
Compartment Syndromes
Fracture Fixation
Open Fractures
Elbow
Reoperation
Demography

Keywords

  • elbow fracture
  • supracondylar humerus fracture
  • type III fracture

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Fletcher, N. D., Schiller, J. R., Garg, S., Weller, A., Larson, A. N., Kwon, M., ... Ho, C. (2012). Increased severity of type III supracondylar humerus fractures in the preteen population. Journal of Pediatric Orthopaedics, 32(6), 567-572. https://doi.org/10.1097/BPO.0b013e31824b542d

Increased severity of type III supracondylar humerus fractures in the preteen population. / Fletcher, Nicholas D.; Schiller, Jonathan R.; Garg, Sumeet; Weller, Amanda; Larson, A. Noelle; Kwon, Michael; Browne, Richard; Copley, Lawson; Ho, Christine.

In: Journal of Pediatric Orthopaedics, Vol. 32, No. 6, 09.2012, p. 567-572.

Research output: Contribution to journalArticle

Fletcher, ND, Schiller, JR, Garg, S, Weller, A, Larson, AN, Kwon, M, Browne, R, Copley, L & Ho, C 2012, 'Increased severity of type III supracondylar humerus fractures in the preteen population', Journal of Pediatric Orthopaedics, vol. 32, no. 6, pp. 567-572. https://doi.org/10.1097/BPO.0b013e31824b542d
Fletcher, Nicholas D. ; Schiller, Jonathan R. ; Garg, Sumeet ; Weller, Amanda ; Larson, A. Noelle ; Kwon, Michael ; Browne, Richard ; Copley, Lawson ; Ho, Christine. / Increased severity of type III supracondylar humerus fractures in the preteen population. In: Journal of Pediatric Orthopaedics. 2012 ; Vol. 32, No. 6. pp. 567-572.
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abstract = "BACKGROUND:: Supracondylar humerus fractures are the most common operative fractures in children; however, no studies describe the older child with this injury. The purpose of this study was to compare Gartland type III supracondylar humerus fractures in children older than 8 years of age with those in younger children than age 8. We hypothesized that there would be more complications in older children, reflecting a higher-energy injury mechanism. METHODS:: A retrospective chart review of supracondylar humerus fractures managed at a single level I pediatric trauma institution from 2004 to 2007 was performed. Patients with type III fractures were divided into groups based on age at presentation greater or less than 8. Baseline demographics, fracture characteristics, mechanism of injury, operative technique, and complications were analyzed. RESULTS:: A consecutive series of 1297 pediatric patients with surgically treated supracondylar humerus fractures was retrospectively reviewed including 873 (67.3{\%}) type III fractures. Of those, 160 (18.3{\%}) patients were older than age 8 at time of injury. Older children were more likely to have fractures from high-energy mechanisms (45.1{\%} vs. 28.7{\%}, P<0.001) and more open fracture (3.8{\%} vs. 1.3{\%}, P=0.0097). There was no difference in preoperative or iatrogenic neuropraxias between groups. There was a shorter delay between presentation and surgery in older children (mean, 217 vs. 451 min, P<0.0001). Three or more pins were used more often in older patients (61.8{\%} in older children vs. 43.6{\%} in younger children, P<0.0001). Major complications including reoperation, loss of fixation, or compartment syndrome were rare in both groups (1.1{\%} in younger group vs. 0.6{\%} in older group, P=1.000). There was a trend toward more pin site infections in older children (3.75{\%} vs. 1.56{\%}, P=0.071). Physical therapy was required nearly 4 times more frequently in older children for management of residual stiffness (20.0{\%} vs. 5.7{\%}, P<0.0001). CONCLUSIONS:: Children older than 8 years of age have a higher rate of open supracondylar humerus fractures, although nerve injury rates are similar. Surgeons placed more pins for fixation of fractures in older patients and elbow stiffness requiring physical therapy occurred more commonly after surgical intervention. EVIDENCE:: III Retrospective cohort.",
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AU - Fletcher, Nicholas D.

AU - Schiller, Jonathan R.

AU - Garg, Sumeet

AU - Weller, Amanda

AU - Larson, A. Noelle

AU - Kwon, Michael

AU - Browne, Richard

AU - Copley, Lawson

AU - Ho, Christine

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N2 - BACKGROUND:: Supracondylar humerus fractures are the most common operative fractures in children; however, no studies describe the older child with this injury. The purpose of this study was to compare Gartland type III supracondylar humerus fractures in children older than 8 years of age with those in younger children than age 8. We hypothesized that there would be more complications in older children, reflecting a higher-energy injury mechanism. METHODS:: A retrospective chart review of supracondylar humerus fractures managed at a single level I pediatric trauma institution from 2004 to 2007 was performed. Patients with type III fractures were divided into groups based on age at presentation greater or less than 8. Baseline demographics, fracture characteristics, mechanism of injury, operative technique, and complications were analyzed. RESULTS:: A consecutive series of 1297 pediatric patients with surgically treated supracondylar humerus fractures was retrospectively reviewed including 873 (67.3%) type III fractures. Of those, 160 (18.3%) patients were older than age 8 at time of injury. Older children were more likely to have fractures from high-energy mechanisms (45.1% vs. 28.7%, P<0.001) and more open fracture (3.8% vs. 1.3%, P=0.0097). There was no difference in preoperative or iatrogenic neuropraxias between groups. There was a shorter delay between presentation and surgery in older children (mean, 217 vs. 451 min, P<0.0001). Three or more pins were used more often in older patients (61.8% in older children vs. 43.6% in younger children, P<0.0001). Major complications including reoperation, loss of fixation, or compartment syndrome were rare in both groups (1.1% in younger group vs. 0.6% in older group, P=1.000). There was a trend toward more pin site infections in older children (3.75% vs. 1.56%, P=0.071). Physical therapy was required nearly 4 times more frequently in older children for management of residual stiffness (20.0% vs. 5.7%, P<0.0001). CONCLUSIONS:: Children older than 8 years of age have a higher rate of open supracondylar humerus fractures, although nerve injury rates are similar. Surgeons placed more pins for fixation of fractures in older patients and elbow stiffness requiring physical therapy occurred more commonly after surgical intervention. EVIDENCE:: III Retrospective cohort.

AB - BACKGROUND:: Supracondylar humerus fractures are the most common operative fractures in children; however, no studies describe the older child with this injury. The purpose of this study was to compare Gartland type III supracondylar humerus fractures in children older than 8 years of age with those in younger children than age 8. We hypothesized that there would be more complications in older children, reflecting a higher-energy injury mechanism. METHODS:: A retrospective chart review of supracondylar humerus fractures managed at a single level I pediatric trauma institution from 2004 to 2007 was performed. Patients with type III fractures were divided into groups based on age at presentation greater or less than 8. Baseline demographics, fracture characteristics, mechanism of injury, operative technique, and complications were analyzed. RESULTS:: A consecutive series of 1297 pediatric patients with surgically treated supracondylar humerus fractures was retrospectively reviewed including 873 (67.3%) type III fractures. Of those, 160 (18.3%) patients were older than age 8 at time of injury. Older children were more likely to have fractures from high-energy mechanisms (45.1% vs. 28.7%, P<0.001) and more open fracture (3.8% vs. 1.3%, P=0.0097). There was no difference in preoperative or iatrogenic neuropraxias between groups. There was a shorter delay between presentation and surgery in older children (mean, 217 vs. 451 min, P<0.0001). Three or more pins were used more often in older patients (61.8% in older children vs. 43.6% in younger children, P<0.0001). Major complications including reoperation, loss of fixation, or compartment syndrome were rare in both groups (1.1% in younger group vs. 0.6% in older group, P=1.000). There was a trend toward more pin site infections in older children (3.75% vs. 1.56%, P=0.071). Physical therapy was required nearly 4 times more frequently in older children for management of residual stiffness (20.0% vs. 5.7%, P<0.0001). CONCLUSIONS:: Children older than 8 years of age have a higher rate of open supracondylar humerus fractures, although nerve injury rates are similar. Surgeons placed more pins for fixation of fractures in older patients and elbow stiffness requiring physical therapy occurred more commonly after surgical intervention. EVIDENCE:: III Retrospective cohort.

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KW - supracondylar humerus fracture

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