Prognostic Factors for the Outcome of Supracondylar Humeral Fractures in Children

Abstract

Objective: To detect the influence of the type of osteosynthesis, the timing of surgery, and the experience of the surgeon on the outcome of supracondylar humeral fractures in children.

Methods: In this study we included 97 patients aged 0 to 18 years with displaced supracondylar humeral fractures that required osteosynthesis within a time period of 5 years. In detail, unstable type II as well as type III and type IV fractures were registered. Fractures were treated with Kirschner wire fixation or with elastic stable intramedullary nailing (ESIN). A C-arm was used to control the position of the fragments. Immobilization, if indicated after the operation, was achieved through the fitting of long-arm plaster, or fiberglass splints. The study was carried out retrospectively. The time period to surgery, the duration of the surgery, the type of osteosynthesis, and the experience of the surgeon were determined and correlated to the incidence of complication intraoperatively, postoperatively, and during the long-term follow-up. The hospital's electronic archive, including all charts and radiological studies, was analyzed. Statistical significance was set at an alpha level of 0.05.

Results: Of the 97 supracondylar fractures in this study, 55 (56.7%) occurred in boys and 42 (43.3%) in girls; the average age was 5.8 years. The outcome of the operation was independent of the time interval between the trauma and the operation as well as the mode of transportation (P > 0.05) because the complication rate did not differ significantly between patients who had surgery on the same day and between patients who waited for up to 2 days for surgery. Furthermore, the duration of surgery and the experience of the performing surgeon did not influence the occurrence of any complications. However, the complication rate increased after operations performed during the night shift. During the shift between 10 pm and 2 am, the incidence of paresthesia was significantly increased (P = 0.01) compared to the shift from 7:30 am to 4:30 pm. However, no difference was detected between business and non-business days regarding any complications. In addition, ESIN and closed reductions resulted in lower complication rates than Kirschner wire fixation and open reductions in this study population.

Conclusion: In our study population, patients undergoing surgery during the night shift, Kirschner wire fixation and open reduction were associated with an increased rate of complications in comparison to operations during the day, closed reduction, and ESIN. Notably, the timing of surgery and the experience of the surgeon did not have any impact on the outcome after supracondylar humeral fracture.

Keywords: Children; Complication; Elastic stable intramedullary nail; Kirschner wire fixation; Supracondylar humeral fractures.

Figure 1

Analysis of the timing of the procedure. (A) The time from trauma to surgery and reveals that the majority of patients was operated on on the day of the trauma or 1 day after. (B) Demonstrates that most procedures took 1 hour.

Figure 2

Analysis of the type of osteosynthesis was conducted and showed that for type II and III fractures mainly elastic stable intramedullary nails (ESIN) were applied whereas type IV fractures were treated mainly with Kirschner wires. However, almost half of the type IV fractures were reduced in a closed manner.

Figure 3

(A) Complications during follow up were considered and a lower rate was noted after elastic stable intramedullary nail (ESIN) than after Kirschner wire fixation. Two cases of a combined osteosynthesis with ESIN/Kirschner wire and screw/Kirschner wire were excluded in this analysis. (B) Comparison of closed to open reduction demonstrated a higher complication rate after open reduction.