Comparison of Acute Complications after Early Versus Delayed Surgical Treatment of Pediatric Elbow Supracondylar Fractures

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Orthopedic Surgery, School of Medicine AND Orthopedic Trauma Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Specialist in Community Medicine, Researcher, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Pediatric supracondylar humeral fractures can be associated with infectious, vascular, and neurological complications. There is debate about emergency or elective treatment methods of this fracture. The aim of this study was to evaluate the passing of time in the treatment of pediatric elbow supracondylar fractures.Methods: In this study, 60 patients underwent early surgery (before 8 hours) and 60 patients with delayed arrival underwent delayed treatment (after 8 hours). After data collection by observation and checklist they were analyzed by means of SPSS software and X2, Fisher’s exact test, t-test, and Mann-Whitney statistical test. P values of > 0.05 were considered significant.Findings: There was no significant difference between the two groups regarding neurovascular injury, infection, myositis ossificans, and varus deformity. Moreover, there was no compartment syndrome in the two groups (P > 0.05).Conclusion: We were unable to identify any significant differences regarding complications such as neurovascular injury, infection, myositis ossificans, and varus deformity between early and delayed treatment groups of pediatric supracondylar humeral fractures. Therefore, the choice between early or delayed operative treatment depends on the surgeon’s preference and judgment.

Keywords


  1. Wilkins KE. Supracondylar fractures of the distal humerus. In: Beaty JH, Kasser JR. RockWood and Wilkins' fractures in children. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 209. p. 486-523.
  2. Koval KJ, Zuckerman JD. Handbook of fractures: Elbow fractures. Trans. Arti HR. Isfahan, Iran: Salamat Publication; 2009. p. 70-89.
  3. Canale ST, Beaty JH. Fractures and dislocations in children. In: Canale ST, Beaty JH, editors. Campbell's operative ortopaedics. 12th ed. Philadelphia, PA: Mosby; 2012. p. 1404-14.
  4. Kihiko D, Mutiso VM, Kiboi JG. Patterns of injuries in children who fall from a height as seen at Kenyatta National Hospital. East Afr Med J 2010; 87(8): 330-4.
  5. Lutz N, Audige L, Schmittenbecher P, Clavert JM, Frick S, Slongo T. Diagnostic algorithm for a validated displacement grading of pediatric supracondylar fractures. J Pediatr Orthop 2011; 31(2): 117-23.
  6. Tomaszewski R, Gap A, Wozowicz A, Wysocka P. Analysis of early vascular and neurological complications of supracondylar humerus fractures in children. Pol Orthop Traumatol 2012; 77: 101-4.
  7. Naranje S, Kancherla R, Kannan A, Malhotra R, Sharma L, Sankineani SR. Extraarticular bony ankylosis in a child with supracondylar fracture of humerus. Chin J Traumatol 2012; 15(5): 300-2.
  8. Mehlman CT, Strub WM, Roy DR, Wall EJ, Crawford AH. The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children. J Bone Joint Surg Am 2001; 83-A(3): 323-7.
  9. Walmsley PJ, Kelly MB, Robb JE, Annan IH, Porter DE. Delay increases the need for open reduction of type-III supracondylar fractures of the humerus. J Bone Joint Surg Br 2006; 88(4): 528-30.
  10. Lee S, Park MS, Chung CY, Kwon DG, Sung KH, Kim TW, et al. Consensus and different perspectives on treatment of supracondylar fractures of the humerus in children. Clin Orthop Surg 2012; 4(1): 91-7.
  11. Mellor SJ, Patel VP, Mehlman CT, Strub WM, Roy DR, Wall EJ, et al. Early or delayed surgical treatment of supracondylar humeral fractures in children. J Bone Joint Surg Am 2002; 84(6): 1078-80.
  12. Sibinski M, Sharma H, Bennet GC. Early versus delayed treatment of extension type-3 supracondylar fractures of the humerus in children. J Bone Joint Surg Br 2006; 88(3): 380-1.
  13. Gupta N, Kay RM, Leitch K, Femino JD, Tolo VT, Skaggs DL. Effect of surgical delay on perioperative complications and need for open reduction in supracondylar humerus fractures in children. J Pediatr Orthop 2004; 24(3): 245-8.
  14. Green NE. Overnight delay in the reduction of supracondylar fractures of the humerus in children. J Bone Joint Surg Am 2001; 83-A(3): 321-2.
  15. Leet AI, Frisancho J, Ebramzadeh E. Delayed treatment of type 3 supracondylar humerus fractures in children. J Pediatr Orthop 2002; 22(2): 203-7.
  16. Iyengar SR, Hoffinger SA, Townsend DR. Early versus delayed reduction and pinning of type III displaced supracondylar fractures of the humerus in children: a comparative study. J Orthop Trauma 1999; 13(1): 51-5.
  17. Dua A, Eachempati KK, Malhotra R, Sharma L, Gidaganti M. Closed reduction and percutaneous pinning of displaced supracondylar fractures of humerus in children with delayed presentation. Chin J Traumatol 2011; 14(1): 14-9.