Pediatric Supracondylar Humerus Fractures: Should We Avoid Surgery during After-Hours?

Abstract

Pediatric supracondylar humerus fractures occur frequently. Often, the decision has to be made whether to operate immediately, e.g., during after-hours, or to postpone until office hours. However, the effect of timing of surgery on radiological and clinical outcomes is unclear. This literature review with the PICO methodology found six relevant articles that compared the results of office-hours and after-hours surgery for pediatric supracondylar humerus fractures. The surgical outcomes of both groups in these studies were assessed. One of the articles found a significantly higher "poor fixation rate" in the after-hours group, compared with office hours. Another article found more malunions in the "night" subgroup vs. the "all groups but night" group. A third article found a higher risk of postoperative paresthesia in the "late night" subgroup vs. the "day" group. Lastly, one article reported increased consultant attendance and decreased operative time when postponing to office hours more often. No differences were reported for functional outcomes in any of the articles. Consequently, no strong risks or benefits from surgical treatment during office hours vs. after-hours were found. It appears safe to postpone surgery to office hours if circumstances are not optimal for acute surgery, and if there is no medical contraindication. However, research with a higher level-of-evidence is needed make more definite recommendations.

Keywords: after-hours; children; fracture; night; orthopedics; reduction; supracondylar humerus; surgery.