Effect of Surgical Delay on Perioperative Complications and Need for Open Reduction in Supracondylar Humerus Fractures in Children

Author(s): Gupta N, Kay R, Leitch K, Femino J, Tolo V, Skaggs D

Source: J Ped Orthop 24: 245-248, 2004.

Summary:

In the past, supracondylar fractures of the humerus in children were treated on an emergent basis.  Recent studies have highlighted that delay in treatment does not significantly alter complication rates.  This retrospective study of 150 children from Children’s Hospital of Los Angeles sought to confirm or refute these previous studies. The authors define delay of surgery as greater than 12 hours from injury.  Children with a vascular deficit, an open fracture, or an ipsilateral fracture were excluded from the cohort.  Fifty children underwent surgery 12 hours or less following injury and 100 patients underwent surgery 12 hours after injury.  One hundred forty nine (149) children were treated with pin fixation from the lateral side only.

There was no significant difference between the early and late groups in rate of open reduction, pin tract infection, iatrogenic nerve injury, vascular complication, or compartment syndrome.  No supracondylar fracture lost reduction clinically or radiographically.  There were no instances of iatrogenic nerve injury or compartment syndrome.  Only one pin tract infection was reported.

This large cohort of patients could not identify significant differences between early and late treatment.  Previous studies have defined late treatment as eight hours from injury.  This study extends late treatment to 12 hours following injury.  In addition, the authors report a lower rate of iatrogenic injury than previous reports.  They attribute their 0% of iatrogenic nerve injuries to the use of pins inserted from the lateral side, which was performed in 149 of the 150 patients.  In addition, lateral pin entry and fixation did not show any evidence of loss of reduction.  The study supports previous reports that isolated supracondylar fractures in children without significant soft-tissue or vascular injury can be treated in a delayed fashion.  Certainly, children with vascular compromise or extensive soft tissue injury require emergent treatment.

 

 

Related Links
Journal of Pediatric Orthopaedics