Steven A Morrison1, Daniel Pincus2,3,4, Mark W Camp1,2. 1. The Hospital for Sick Children, Division of Orthopaedics, Department of Surgery, Toronto, Ontario. 2. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario. 3. Institute for Clinical Evaluative Sciences, Toronto, Ontario. 4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.
Abstract
BACKGROUND: Supracondylar humerus (SCH) fractures are the most common operatively treated paediatric fracture in Canada. Previous literature describing the low-energy (Gartland type II) subtype reports varying complication rates from a variety of practice settings. We sought to examine complications of type II SCH fractures treated at a Canadian specialized paediatric centre. METHODS: We conducted a retrospective cohort study of patients aged 0 to 14 admitted to SickKids, Toronto, Ontario for surgical treatment of a type II SCH fracture from 2008 to 2015. The primary outcome of this study was relevant perioperative complications including: open fracture, compartment syndrome, pre- and postoperative vascular compromise, pre- and postoperative neurological compromise, failure to obtain a closed reduction (i.e., open reduction), postoperative infection, and reoperation within 3 months. RESULTS: There were 370 patients included in the study with mean (standard deviation) age 5.14 years (±2.51). The overall rate of relevant complications in the study cohort was 3.6% (13/358, 12 missing), with 12 cases of nerve palsy (3.3%; 2 iatrogenic [0.6%]) that resolved by final follow-up and one case of preoperative nerve palsy (0.3%) that did not. Importantly, there were no cases of vascular compromise, open fracture, compartment syndrome, or infection. DISCUSSION AND CONCLUSION: Complications associated with type II SCH fractures managed at a specialized paediatric centre that result in long-term morbidity are extremely rare (0.3%). Perioperative inpatient monitoring for patients with these fractures may not be justified based on these data. Prospective studies are required to confirm safety, evaluate patient perspectives, and demonstrate cost savings of outpatient surgical management.
BACKGROUND: Supracondylar humerus (SCH) fractures are the most common operatively treated paediatric fracture in Canada. Previous literature describing the low-energy (Gartland type II) subtype reports varying complication rates from a variety of practice settings. We sought to examine complications of type II SCH fractures treated at a Canadian specialized paediatric centre. METHODS: We conducted a retrospective cohort study of patients aged 0 to 14 admitted to SickKids, Toronto, Ontario for surgical treatment of a type II SCH fracture from 2008 to 2015. The primary outcome of this study was relevant perioperative complications including: open fracture, compartment syndrome, pre- and postoperative vascular compromise, pre- and postoperative neurological compromise, failure to obtain a closed reduction (i.e., open reduction), postoperative infection, and reoperation within 3 months. RESULTS: There were 370 patients included in the study with mean (standard deviation) age 5.14 years (±2.51). The overall rate of relevant complications in the study cohort was 3.6% (13/358, 12 missing), with 12 cases of nerve palsy (3.3%; 2 iatrogenic [0.6%]) that resolved by final follow-up and one case of preoperative nerve palsy (0.3%) that did not. Importantly, there were no cases of vascular compromise, open fracture, compartment syndrome, or infection. DISCUSSION AND CONCLUSION: Complications associated with type II SCH fractures managed at a specialized paediatric centre that result in long-term morbidity are extremely rare (0.3%). Perioperative inpatient monitoring for patients with these fractures may not be justified based on these data. Prospective studies are required to confirm safety, evaluate patient perspectives, and demonstrate cost savings of outpatient surgical management.
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