Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Dec;30(8):785-91.
doi: 10.1097/BPO.0b013e3181f9fc03.

The effects of surgical delay on the outcome of pediatric supracondylar humeral fractures

Joshua G Bales  1 , Hillard T Spencer, Melissa A Wong, Yi-Jen Fong, Lewis E Zionts, Mauricio Silva
Affiliations

The effects of surgical delay on the outcome of pediatric supracondylar humeral fractures

Joshua G Bales et al. J Pediatr Orthop. 2010 Dec.

Abstract

Background: Occasionally, the treatment of a pediatric supracondylar humeral fracture is delayed owing to lack of an available treating physician, necessitating transfer of the child, or delay in availability of an operating room. The purpose of this study is to prospectively evaluate whether delayed pinning of these fractures affects the outcome or number of complications.

Methods: We reviewed information that was prospectively collected on 145 pediatric supracondylar humeral fractures that were treated by closed reduction and percutaneous pinning, with a minimum follow-up of 8 weeks. To determine the effect of delayed treatment, we compared a group of fractures that was treated within the first 21 hours after their presentation to our urgent care center (Group A) with a group that was treated after more than 21 hours (Group B). We compared the following variables: need for open reduction, length of surgery, length of hospitalization, the presence of neurologic complications, vascular complications including compartment syndrome, pin tract infection, loss of fixation, final carrying angle, range of motion, and outcome.

Results: Overall, the mean time from presentation to surgery for both groups was 52 hours. This interval was greater for Gartland type II fractures (65 h) than for Gartland type III fractures (19 h) (P=0.00001). There was no need for an open reduction in either group. There were no significant differences between the groups regarding iatrogenic nerve injuries, vascular complications, compartment syndromes, surgical time, final carrying angle, range of motion, and outcome.

Conclusions: The results of this prospective study found that a delay in pinning closed supracondylar humeral fractures in children did not lead to a higher incidence of open reduction or a greater number of complications. Although the urgency of treating any child with a supracondylar fracture should be individualized, our study suggests that most of these injuries can be managed safely in a delayed fashion without compromising the clinical outcome. We recommend careful monitoring of any patient with type 3 injury whose treatment is delayed.

Level of evidence: II.

PubMed Disclaimer