Article
Does operative timing of pediatric supracondylar humerus fractures affect postoperative early complications?
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Authors
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Seigo Suganuma
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Kaoru Tada
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan
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Hidetoshi Yasutake
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Takeshi Horii
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Munetomo Takata
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Keito Shimanuki
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Daiyu Tsuji
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Kanu Shimokawa
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: The purpose of this study is to evaluate whether the time to surgery of Gartland type II and III pediatric supracondylar humerus fractures affects the incidence of postoperative early complications.
Methods: We retrospectively reviewed 172 pediatric patients aged 1 to 15 years who sustained Gartland type II and III supracondylar humerus fractures and who had been operated in our associated institutions between April 2007 and March 2017. Patients with polytrauma, open fractures and neurovascular injury at an initial examination were excluded from this study. As a result, 142 patients were included in this study. The 91 boys and 51 girls with a mean age of 6.5 years included 66 type II and 76 type III Gartland type fractures. The time from fracture to surgery was calculated from the medical records for each patient. The outcome measures evaluated were the incidence of postoperative early complications and the conversion rate to open reduction in type III cases. We defined patients treated within 12 hours as the Early group (EII for type II and EIII for type III) and those treated more than 12 hours after the injury as the Delayed group (DII for type II and DIII for type III). The analysis of group differences was performed using a Fisher's exact test.
Results: There were 10 complications in 66 type II patients (15.2%) and 14 in 76 type III patients (18.4%). All complications in type II cases were surgical site infections. There was no significant difference between EII and DII. Complications in type III cases consisted of surgical site infections (n = 8, 10.5%) and postoperative neurological deficits (n = 6, 7.9%). There was no significant difference between EIII and DIII. No iatrogenic ulnar nerve injury or compartment syndrome was observed in either type II or III cases. No patients needed to return to the operating room. Conversion to open reduction was needed in 3 patients in EIII (4.8%) and 0 in DIII (0%).
Conclusions: Delayed surgery was not associated with an increased rate of postoperative early complications or the conversion rate to open reduction. We suggest that it is not necessary to perform emergency surgery for type II cases. On the other hand, type III cases are usually treated on an emergency basis. It is still controversial whether the delay of surgery is permissive for type III fractures. Our findings suggest it is possible to treat closed type III fractures without neurovascular injuries in a less urgent manner.
