Emergency room closed reduction versus in situ splinting in the treatment of paediatric supracondylar humerus fractures

S. M. Sylvia, K. J. Maguire, D. A. Molho, B. J. Levens, M. E. Stone, R. Hanstein, J. F. Schulz, E. D. Fornari

Research output: Contribution to journalArticle

Abstract

Purpose Displaced supracondylar humerus fractures are treated with open or closed reduction and percutaneous pinning. In 2012, our management of patients with a displaced fracture changed from closed reduction in the emergency department (ED) to in situ splinting prior to closed reduction and pinning in the operating room (OR). The purpose of this study was to investigate if outcomes or complications differ between these two management methods. Methods Patients less than ten years old with a Gartland type II or III supracondylar humerus fracture between 2008 and 2016 were included. Cases of polytrauma were excluded. Radiographic outcomes were assessed at follow-up. The Fisher’s exact test was used for categorical variables and the Wilcoxon rank sums tests for continuous variables. Results In all, 157 patients were included, 89 with reduction in the ED and 68 without. There was no significant difference between the groups related to demographic factors or fracture characteristics. Patients managed without reduction in the ED had a lower average delay from ED to OR compared with those treated with reduction (16 hours versus 22 hours, p < 0.005) and a shorter hospital length of stay (34 hours versus 40 hours, p < 0.005). Conclusion No difference in complications or outcomes was found between patients with Type II or III supracondylar fractures treated initially with or without closed reduction in the ED. Patients treated without ED reduction were taken to the OR sooner and remained in the hospital for a shorter period of time. Splinting in situ reduces anaesthesia exposure without increasing postoperative complications or suboptimal outcomes.

Original languageEnglish (US)
Pages (from-to)334-339
Number of pages6
JournalJournal of Children's Orthopaedics
Volume13
Issue number3
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Humerus
Hospital Emergency Service
Pediatrics
Operating Rooms
Nonparametric Statistics
Length of Stay
Therapeutics
Multiple Trauma
Anesthesia
Demography

Keywords

  • Closed reduction
  • Humerus fracture
  • Paediatric
  • Splinting in situ
  • Supracondylar fracture

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Emergency room closed reduction versus in situ splinting in the treatment of paediatric supracondylar humerus fractures. / Sylvia, S. M.; Maguire, K. J.; Molho, D. A.; Levens, B. J.; Stone, M. E.; Hanstein, R.; Schulz, J. F.; Fornari, E. D.

In: Journal of Children's Orthopaedics, Vol. 13, No. 3, 01.01.2019, p. 334-339.

Research output: Contribution to journalArticle

Sylvia, S. M. ; Maguire, K. J. ; Molho, D. A. ; Levens, B. J. ; Stone, M. E. ; Hanstein, R. ; Schulz, J. F. ; Fornari, E. D. / Emergency room closed reduction versus in situ splinting in the treatment of paediatric supracondylar humerus fractures. In: Journal of Children's Orthopaedics. 2019 ; Vol. 13, No. 3. pp. 334-339.
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abstract = "Purpose Displaced supracondylar humerus fractures are treated with open or closed reduction and percutaneous pinning. In 2012, our management of patients with a displaced fracture changed from closed reduction in the emergency department (ED) to in situ splinting prior to closed reduction and pinning in the operating room (OR). The purpose of this study was to investigate if outcomes or complications differ between these two management methods. Methods Patients less than ten years old with a Gartland type II or III supracondylar humerus fracture between 2008 and 2016 were included. Cases of polytrauma were excluded. Radiographic outcomes were assessed at follow-up. The Fisher’s exact test was used for categorical variables and the Wilcoxon rank sums tests for continuous variables. Results In all, 157 patients were included, 89 with reduction in the ED and 68 without. There was no significant difference between the groups related to demographic factors or fracture characteristics. Patients managed without reduction in the ED had a lower average delay from ED to OR compared with those treated with reduction (16 hours versus 22 hours, p < 0.005) and a shorter hospital length of stay (34 hours versus 40 hours, p < 0.005). Conclusion No difference in complications or outcomes was found between patients with Type II or III supracondylar fractures treated initially with or without closed reduction in the ED. Patients treated without ED reduction were taken to the OR sooner and remained in the hospital for a shorter period of time. Splinting in situ reduces anaesthesia exposure without increasing postoperative complications or suboptimal outcomes.",
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AU - Sylvia, S. M.

AU - Maguire, K. J.

AU - Molho, D. A.

AU - Levens, B. J.

AU - Stone, M. E.

AU - Hanstein, R.

AU - Schulz, J. F.

AU - Fornari, E. D.

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N2 - Purpose Displaced supracondylar humerus fractures are treated with open or closed reduction and percutaneous pinning. In 2012, our management of patients with a displaced fracture changed from closed reduction in the emergency department (ED) to in situ splinting prior to closed reduction and pinning in the operating room (OR). The purpose of this study was to investigate if outcomes or complications differ between these two management methods. Methods Patients less than ten years old with a Gartland type II or III supracondylar humerus fracture between 2008 and 2016 were included. Cases of polytrauma were excluded. Radiographic outcomes were assessed at follow-up. The Fisher’s exact test was used for categorical variables and the Wilcoxon rank sums tests for continuous variables. Results In all, 157 patients were included, 89 with reduction in the ED and 68 without. There was no significant difference between the groups related to demographic factors or fracture characteristics. Patients managed without reduction in the ED had a lower average delay from ED to OR compared with those treated with reduction (16 hours versus 22 hours, p < 0.005) and a shorter hospital length of stay (34 hours versus 40 hours, p < 0.005). Conclusion No difference in complications or outcomes was found between patients with Type II or III supracondylar fractures treated initially with or without closed reduction in the ED. Patients treated without ED reduction were taken to the OR sooner and remained in the hospital for a shorter period of time. Splinting in situ reduces anaesthesia exposure without increasing postoperative complications or suboptimal outcomes.

AB - Purpose Displaced supracondylar humerus fractures are treated with open or closed reduction and percutaneous pinning. In 2012, our management of patients with a displaced fracture changed from closed reduction in the emergency department (ED) to in situ splinting prior to closed reduction and pinning in the operating room (OR). The purpose of this study was to investigate if outcomes or complications differ between these two management methods. Methods Patients less than ten years old with a Gartland type II or III supracondylar humerus fracture between 2008 and 2016 were included. Cases of polytrauma were excluded. Radiographic outcomes were assessed at follow-up. The Fisher’s exact test was used for categorical variables and the Wilcoxon rank sums tests for continuous variables. Results In all, 157 patients were included, 89 with reduction in the ED and 68 without. There was no significant difference between the groups related to demographic factors or fracture characteristics. Patients managed without reduction in the ED had a lower average delay from ED to OR compared with those treated with reduction (16 hours versus 22 hours, p < 0.005) and a shorter hospital length of stay (34 hours versus 40 hours, p < 0.005). Conclusion No difference in complications or outcomes was found between patients with Type II or III supracondylar fractures treated initially with or without closed reduction in the ED. Patients treated without ED reduction were taken to the OR sooner and remained in the hospital for a shorter period of time. Splinting in situ reduces anaesthesia exposure without increasing postoperative complications or suboptimal outcomes.

KW - Closed reduction

KW - Humerus fracture

KW - Paediatric

KW - Splinting in situ

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